Provider Demographics
NPI:1275609281
Name:MEDVECKIS, JOHN FORTUNE (MA,LAC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:FORTUNE
Last Name:MEDVECKIS
Suffix:
Gender:M
Credentials:MA,LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 LA VUELTA RD
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93108-2621
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:315 W HALEY ST STE 102
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-8052
Practice Address - Country:US
Practice Address - Phone:805-966-3310
Practice Address - Fax:805-966-5582
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health