Provider Demographics
NPI:1609940600
Name:ABBOTT, MARK NICHOLAS (MA, MFT)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:NICHOLAS
Last Name:ABBOTT
Suffix:
Gender:M
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:940 S COAST DR
Mailing Address - Street 2:SUITE 250
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-7735
Mailing Address - Country:US
Mailing Address - Phone:714-546-2515
Mailing Address - Fax:714-276-1351
Practice Address - Street 1:940 S COAST DR
Practice Address - Street 2:SUITE 250
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-7735
Practice Address - Country:US
Practice Address - Phone:714-546-2515
Practice Address - Fax:714-276-1351
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 33780101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health