Provider Demographics
NPI:1922142132
Name:OAKLEY, MARK (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:OAKLEY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:499 N CANON DR
Mailing Address - Street 2:SUITE 307
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4842
Mailing Address - Country:US
Mailing Address - Phone:310-858-0240
Mailing Address - Fax:310-887-7016
Practice Address - Street 1:499 N CANON DR
Practice Address - Street 2:SUITE 307
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4842
Practice Address - Country:US
Practice Address - Phone:310-858-0240
Practice Address - Fax:310-887-7016
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY9870103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY9870OtherSTATE LICENSE