Healthcare Provider Details

I. General information

NPI: 1275609281
Provider Name (Legal Business Name): JOHN FORTUNE MEDVECKIS MA.,LAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 W HALEY ST STE 102
SANTA BARBARA CA
93101-8052
US

IV. Provider business mailing address

99 LA VUELTA RD
SANTA BARBARA CA
93108-2621
US

V. Phone/Fax

Practice location:
  • Phone: 805-966-3310
  • Fax: 805-966-5582
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: