1366504409 NPI number — MR. RICHARD LLOYD DONALDSON LCSW

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366504409 NPI number — MR. RICHARD LLOYD DONALDSON LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DONALDSON
Provider First Name:
RICHARD
Provider Middle Name:
LLOYD
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366504409
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3200 W MONTE VISTA AVE
Provider Second Line Business Mailing Address:
SUITE A-1, #172
Provider Business Mailing Address City Name:
TURLOCK
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95380-8412
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
209-402-9645
Provider Business Mailing Address Fax Number:
209-667-5325

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
134 REGIS ST
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
TURLOCK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95382-1130
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-402-9645
Provider Business Practice Location Address Fax Number:
209-667-5325
Provider Enumeration Date:
12/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  LCS 15396 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 10 . This is a "BEHAVIORAL HEALTH PROVIDE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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