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Provider Information for 1619721073


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PATRICK ANTHONY TALBOT LMFT


Sex: Male

NPI: 1619721073
Last Updated: 2024-04-12
Certification Date: 2024-04-12

Details

NameValue
NPI1619721073
Enumeration Date2024-04-12
NPI TypeNPI-1 Individual
Sole ProprietorYES
StatusActive
Mailing Address 1030 DRIFTWOOD LN
VENTURA, CA 93001-0823
United States

Phone: 805-798-3427 | Fax:
 
Primary Practice Address 1030 DRIFTWOOD LN
VENTURA, CA 93001-0823
United States

Phone: 805-798-3427 | Fax:
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
Yes 106H00000X - Marriage & Family Therapist CA46943