Healthcare Provider Details

I. General information

NPI: 1629192539
Provider Name (Legal Business Name): DOUG HRABKO MA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

627 16TH ST
ARCATA CA
95521-5605
US

IV. Provider business mailing address

PO BOX 1052
BLUE LAKE CA
95525-1052
US

V. Phone/Fax

Practice location:
  • Phone: 707-822-4645
  • Fax: 707-822-4645
Mailing address:
  • Phone: 707-822-4645
  • Fax: 707-822-4645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC39543
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: