Healthcare Provider Details

I. General information

NPI: 1194927517
Provider Name (Legal Business Name): DAVID R. SYKES MFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

144 OAKWOOD DR
AUBURN CA
95603-5114
US

IV. Provider business mailing address

144 OAKWOOD DR
AUBURN CA
95603-5114
US

V. Phone/Fax

Practice location:
  • Phone: 530-885-0360
  • Fax: 530-885-7059
Mailing address:
  • Phone: 530-885-0360
  • Fax: 530-885-7059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC28764
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: