Provider Demographics
NPI:1568903748
Name:MARKLE, ADAM (LMFT 122790)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:MARKLE
Suffix:
Gender:M
Credentials:LMFT 122790
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3681 KEATING ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-1918
Mailing Address - Country:US
Mailing Address - Phone:619-708-2493
Mailing Address - Fax:
Practice Address - Street 1:3681 KEATING ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-1918
Practice Address - Country:US
Practice Address - Phone:619-708-2493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-20
Last Update Date:2021-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA122790106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist