Provider Demographics
NPI:1922065564
Name:SEATON-BACON, AUDREY ELAINE (PHD)
Entity Type:Individual
Prefix:DR
First Name:AUDREY
Middle Name:ELAINE
Last Name:SEATON-BACON
Suffix:
Gender:F
Credentials:PHD
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 585
Mailing Address - Street 2:
Mailing Address - City:PARK HILLS
Mailing Address - State:MO
Mailing Address - Zip Code:63601-0585
Mailing Address - Country:US
Mailing Address - Phone:562-907-9196
Mailing Address - Fax:562-479-0365
Practice Address - Street 1:1338 CENTER COURT DR STE 102
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91724-3681
Practice Address - Country:US
Practice Address - Phone:562-907-9196
Practice Address - Fax:562-479-0365
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY16171103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical