Provider Demographics
NPI:1598829756
Name:MCDOUGALD, FRANK CORNELL
Entity Type:Individual
Prefix:
First Name:FRANK
Middle Name:CORNELL
Last Name:MCDOUGALD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:724 DELAWARE ST
Mailing Address - Street 2:APT 1
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-6245
Mailing Address - Country:US
Mailing Address - Phone:707-720-8904
Mailing Address - Fax:
Practice Address - Street 1:1745 ENTERPRISE DR BLDG 2
Practice Address - Street 2:SUITE I-64
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-5801
Practice Address - Country:US
Practice Address - Phone:707-427-6640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist