Provider Demographics
NPI:1942323142
Name:PROCTOR, PATRICK TERRANCE (MFT)
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:TERRANCE
Last Name:PROCTOR
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 HANOVER LN
Mailing Address - Street 2:SUITE D
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95973-7269
Mailing Address - Country:US
Mailing Address - Phone:530-898-1865
Mailing Address - Fax:530-898-1865
Practice Address - Street 1:21 HANOVER LN
Practice Address - Street 2:SUITE D
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95973-7269
Practice Address - Country:US
Practice Address - Phone:530-898-1865
Practice Address - Fax:530-898-1865
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 35303106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist