Provider Demographics
NPI:1639810898
Name:SIEGEL, DAVID GABRIEL (LMFT)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:GABRIEL
Last Name:SIEGEL
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:GABRIEL
Other - Middle Name:
Other - Last Name:SIEGEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT
Mailing Address - Street 1:PO BOX 1481
Mailing Address - Street 2:
Mailing Address - City:POINT REYES STATION
Mailing Address - State:CA
Mailing Address - Zip Code:94956-1481
Mailing Address - Country:US
Mailing Address - Phone:949-667-2488
Mailing Address - Fax:
Practice Address - Street 1:21 PORTOLA RD.
Practice Address - Street 2:APT 1481
Practice Address - City:POINT REYES STATION
Practice Address - State:CA
Practice Address - Zip Code:94956
Practice Address - Country:US
Practice Address - Phone:949-667-2488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-04
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA131194106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist