Provider Demographics
NPI:1912336751
Name:PATRICIA TEMPLE
Entity Type:Organization
Organization Name:PATRICIA TEMPLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LMFT
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:E
Authorized Official - Last Name:TEMPLE
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:916-396-3456
Mailing Address - Street 1:1504 GATEWAY CT
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95618-6406
Mailing Address - Country:US
Mailing Address - Phone:916-396-3456
Mailing Address - Fax:
Practice Address - Street 1:1550 HARBOR BLVD
Practice Address - Street 2:210
Practice Address - City:WEST SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95691-3826
Practice Address - Country:US
Practice Address - Phone:916-396-3456
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-02
Last Update Date:2013-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45408106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5922993OtherAETNA