Provider Demographics
NPI:1225230212
Name:SCALES, M DONOVAN
Entity Type:Individual
Prefix:MR
First Name:M
Middle Name:DONOVAN
Last Name:SCALES
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:MICHAEL
Other - Middle Name:DONOVAN
Other - Last Name:SCALES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MFT
Mailing Address - Street 1:PO BOX 3417
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-0341
Mailing Address - Country:US
Mailing Address - Phone:800-660-8011
Mailing Address - Fax:707-257-8612
Practice Address - Street 1:1300 OLIVER RD
Practice Address - Street 2:SUITE 193
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94534-3413
Practice Address - Country:US
Practice Address - Phone:707-399-9300
Practice Address - Fax:707-257-8612
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12358106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist