Provider Demographics
NPI:1225386485
Name:SLINKARD, RICHARD FREDRIC (MFT)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:FREDRIC
Last Name:SLINKARD
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 1:9910 MIRA MESA BLVD STE D3
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131-1066
Mailing Address - Country:US
Mailing Address - Phone:858-413-5002
Mailing Address - Fax:858-549-9679
Practice Address - Street 1:9910 MIRA MESA BLVD STE D3
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92131-1066
Practice Address - Country:US
Practice Address - Phone:858-413-5002
Practice Address - Fax:858-549-9679
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-20
Last Update Date:2012-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC25850106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist