Healthcare Provider Details

I. General information

NPI: 1144074774
Provider Name (Legal Business Name): DAVID EMMETT ABEYTA AMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2024
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3212 URANUS DR
CERES CA
95307-3010
US

IV. Provider business mailing address

PO BOX 490
CERES CA
95307-0490
US

V. Phone/Fax

Practice location:
  • Phone: 209-531-2088
  • Fax:
Mailing address:
  • Phone: 209-531-2088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number144569
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: