Healthcare Provider Details

I. General information

NPI: 1568683092
Provider Name (Legal Business Name): DR. DAN SLEETH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 07/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

991 PARALLEL DR.
LAKEPORT CA
95453
US

IV. Provider business mailing address

12175 SHENANDOAH RD
MIDDLETOWN CA
95461-7707
US

V. Phone/Fax

Practice location:
  • Phone: 707-994-7090
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC 47501
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: