Provider Demographics
NPI:1265665640
Name:WAYTE, DAVID ALAN (MFT)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:ALAN
Last Name:WAYTE
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 1:1830 TISSERAND DR
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-7635
Mailing Address - Country:US
Mailing Address - Phone:707-293-4290
Mailing Address - Fax:707-576-2239
Practice Address - Street 1:825 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-4108
Practice Address - Country:US
Practice Address - Phone:707-293-4290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-01
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 35503106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist