Provider Demographics
NPI:1194867820
Name:MEARES, FRED ALAN (MFT)
Entity Type:Individual
Prefix:MR
First Name:FRED
Middle Name:ALAN
Last Name:MEARES
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 1:202 AIRPORT DR.
Mailing Address - Street 2:#230
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408
Mailing Address - Country:US
Mailing Address - Phone:909-383-7100
Mailing Address - Fax:909-890-0244
Practice Address - Street 1:202 AIRPORT DR.
Practice Address - Street 2:#230
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408
Practice Address - Country:US
Practice Address - Phone:909-383-7100
Practice Address - Fax:909-890-0244
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC25038106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist