Provider Demographics
NPI:1770735490
Name:PAUL M. FICK, PH.D.
Entity type:Organization
Organization Name:PAUL M. FICK, PH.D.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:M
Authorized Official - Last Name:FICK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:949-916-5060
Mailing Address - Street 1:28281 CROWN VALLEY PKWY STE 225
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-1483
Mailing Address - Country:US
Mailing Address - Phone:949-916-5060
Mailing Address - Fax:949-916-5075
Practice Address - Street 1:28281 CROWN VALLEY PKWY STE 225
Practice Address - Street 2:
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-1483
Practice Address - Country:US
Practice Address - Phone:949-916-5060
Practice Address - Fax:949-916-5075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-13
Last Update Date:2008-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 18298106H00000X
CAPSY 12618103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty