Provider Demographics
NPI:1255497558
Name:ROOT, DAVID ALLEN (MFT, CEAP)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:ALLEN
Last Name:ROOT
Suffix:
Gender:M
Credentials:MFT, CEAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3775 CONSTELLATION RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:LOMPOC
Mailing Address - State:CA
Mailing Address - Zip Code:93436-0426
Mailing Address - Country:US
Mailing Address - Phone:805-733-1916
Mailing Address - Fax:805-733-2016
Practice Address - Street 1:3775 CONSTELLATION RD
Practice Address - Street 2:SUITE 3
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-0426
Practice Address - Country:US
Practice Address - Phone:805-733-1916
Practice Address - Fax:805-733-2016
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC7249101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health