Healthcare Provider Details

I. General information

NPI: 1104949155
Provider Name (Legal Business Name): RICHARD ALAN SALISBURY MFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1212 N CALIFORNIA ST
STOCKTON CA
95202-1552
US

IV. Provider business mailing address

5915 WESTMINSTER CT
RIVERBANK CA
95367-9671
US

V. Phone/Fax

Practice location:
  • Phone: 209-468-2389
  • Fax: 209-468-8024
Mailing address:
  • Phone: 209-869-5292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC38420
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: