Healthcare Provider Details

I. General information

NPI: 1164587705
Provider Name (Legal Business Name): MARK LLOYD STREETS PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1660 HUMBOLDT RD SUITE 3
CHICO CA
95928-9199
US

IV. Provider business mailing address

1660 HUMBOLDT RD SUITE 3
CHICO CA
95928-9199
US

V. Phone/Fax

Practice location:
  • Phone: 530-891-6521
  • Fax:
Mailing address:
  • Phone: 530-891-6521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY11878
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: