Provider Demographics
NPI:1811723620
Name:SPRAGUE, DAVID PAUL JR (MA)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:PAUL
Last Name:SPRAGUE
Suffix:JR
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4125 ASPEN SPRINGS CT
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002-5152
Mailing Address - Country:US
Mailing Address - Phone:530-310-0933
Mailing Address - Fax:
Practice Address - Street 1:1726 TEHAMA ST
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-1615
Practice Address - Country:US
Practice Address - Phone:530-310-0933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-09
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA149067102L00000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst