Provider Demographics
NPI:1164937918
Name:FENTON, WILLIAM ARNOLD (MFT)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:ARNOLD
Last Name:FENTON
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4956 1/2 FIELD ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-2222
Mailing Address - Country:US
Mailing Address - Phone:619-987-3997
Mailing Address - Fax:
Practice Address - Street 1:4956 1/2 FIELD ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-2222
Practice Address - Country:US
Practice Address - Phone:619-987-3997
Practice Address - Fax:619-987-3997
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-01
Last Update Date:2017-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC32307101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor