Provider Demographics
NPI:1831207489
Name:MYATT, RICHARD GEORGE (LMFT)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:GEORGE
Last Name:MYATT
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:966 BIDWELL RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773-1566
Mailing Address - Country:US
Mailing Address - Phone:626-524-2152
Mailing Address - Fax:909-365-4086
Practice Address - Street 1:17133 ARROW BLVD STE A
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-4051
Practice Address - Country:US
Practice Address - Phone:909-251-4654
Practice Address - Fax:909-365-4086
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT 33223106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist