Healthcare Provider Details

I. General information

NPI: 1770735490
Provider Name (Legal Business Name): PAUL M. FICK, PH.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2008
Last Update Date: 10/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28281 CROWN VALLEY PKWY STE 225
LAGUNA NIGUEL CA
92677-1483
US

IV. Provider business mailing address

28281 CROWN VALLEY PKWY STE 225
LAGUNA NIGUEL CA
92677-1483
US

V. Phone/Fax

Practice location:
  • Phone: 949-916-5060
  • Fax: 949-916-5075
Mailing address:
  • Phone: 949-916-5060
  • Fax: 949-916-5075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY 12618
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberPSY 18298
License Number StateCA

VIII. Authorized Official

Name: DR. PAUL M. FICK
Title or Position: OWNER/PSYCHOLOGIST
Credential: PH.D.
Phone: 949-916-5060