Provider Demographics
NPI:1144604588
Name:SEALS, NEIL PATRICK
Entity Type:Individual
Prefix:MR
First Name:NEIL
Middle Name:PATRICK
Last Name:SEALS
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:NEIL
Other - Middle Name:PATRICK
Other - Last Name:SEALS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT
Mailing Address - Street 1:6707 EMBARCADERO DR
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95219-3382
Mailing Address - Country:US
Mailing Address - Phone:209-956-4240
Mailing Address - Fax:209-956-4245
Practice Address - Street 1:6707 EMBARCADERO DR
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95219-3382
Practice Address - Country:US
Practice Address - Phone:209-956-4240
Practice Address - Fax:209-956-4245
Is Sole Proprietor?:No
Enumeration Date:2015-07-15
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16056106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA16056Medicaid