Provider Demographics
NPI:1669675237
Name:MCADAMS, ANTHONY MICHAEL
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:MICHAEL
Last Name:MCADAMS
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:P.O. BOX 2457
Mailing Address - Street 2:13333 PALMDALE RD.
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92393
Mailing Address - Country:US
Mailing Address - Phone:760-241-4917
Mailing Address - Fax:760-241-8911
Practice Address - Street 1:13333 PALMDALE RD.
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92393
Practice Address - Country:US
Practice Address - Phone:760-241-4917
Practice Address - Fax:760-241-8911
Is Sole Proprietor?:No
Enumeration Date:2007-06-08
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5609OtherSIMON STAFF NUMBER