Provider Demographics
NPI:1972605780
Name:SKELTON, MARC D (PHD, PSYD)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:D
Last Name:SKELTON
Suffix:
Gender:M
Credentials:PHD, PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30131 TOWN CENTER DR
Mailing Address - Street 2:SUITE # 280
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-2086
Mailing Address - Country:US
Mailing Address - Phone:949-495-3701
Mailing Address - Fax:949-495-7686
Practice Address - Street 1:30131 TOWN CENTER DR
Practice Address - Street 2:SUITE # 280
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-2086
Practice Address - Country:US
Practice Address - Phone:949-495-3701
Practice Address - Fax:949-495-7686
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2015-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY8082103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP8082Medicare PIN
CA33-0138147OtherEIN
CAR62272Medicare UPIN