Provider Demographics
NPI:1700924867
Name:WAYNE, DAVID JOHN (MFT)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:JOHN
Last Name:WAYNE
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 1:250 W MAIN ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-7724
Mailing Address - Country:US
Mailing Address - Phone:714-730-7737
Mailing Address - Fax:
Practice Address - Street 1:250 W MAIN ST
Practice Address - Street 2:SUITE 201
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-7724
Practice Address - Country:US
Practice Address - Phone:714-730-7737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMX7346106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist