Provider Demographics
NPI:1629192539
Name:HRABKO, DOUG (MA)
Entity Type:Individual
Prefix:MR
First Name:DOUG
Middle Name:
Last Name:HRABKO
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:PO BOX 1052
Mailing Address - Street 2:
Mailing Address - City:BLUE LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:95525-1052
Mailing Address - Country:US
Mailing Address - Phone:707-822-4645
Mailing Address - Fax:707-822-4645
Practice Address - Street 1:627 16TH ST
Practice Address - Street 2:
Practice Address - City:ARCATA
Practice Address - State:CA
Practice Address - Zip Code:95521-5605
Practice Address - Country:US
Practice Address - Phone:707-822-4645
Practice Address - Fax:707-822-4645
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC39543106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist