Provider Demographics
NPI:1447779947
Name:PRATT, DEREK ANTHONY (MA)
Entity Type:Individual
Prefix:MR
First Name:DEREK
Middle Name:ANTHONY
Last Name:PRATT
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4713 ANGELES VISTA BLVD
Mailing Address - Street 2:
Mailing Address - City:VIEW PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90043-1147
Mailing Address - Country:US
Mailing Address - Phone:310-800-6230
Mailing Address - Fax:
Practice Address - Street 1:300 N SAN ANTONIO RD BLDG 3
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93110-1316
Practice Address - Country:US
Practice Address - Phone:805-681-5450
Practice Address - Fax:805-681-4747
Is Sole Proprietor?:No
Enumeration Date:2017-09-15
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA4666844Medicaid