Provider Demographics
NPI:1164791109
Name:SEYMOUR, ROBERT RADCLIFFE (LMFCT)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:RADCLIFFE
Last Name:SEYMOUR
Suffix:
Gender:M
Credentials:LMFCT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17705 HALE AVE
Mailing Address - Street 2:SUITE H2
Mailing Address - City:MORGAN HILL
Mailing Address - State:CA
Mailing Address - Zip Code:95037-4340
Mailing Address - Country:US
Mailing Address - Phone:408-778-2604
Mailing Address - Fax:408-778-2126
Practice Address - Street 1:17705 HALE AVENUE
Practice Address - Street 2:SUITE H2
Practice Address - City:MORGAN HILL
Practice Address - State:CA
Practice Address - Zip Code:95037
Practice Address - Country:US
Practice Address - Phone:408-778-2604
Practice Address - Fax:408-778-2126
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-20
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAM19146101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health