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General NPI Number Information
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NPI Number | 1063687481
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Entity Type | Individual
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Provider Name | MARK ALLEN SPURLOCK M.F.T.
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Gender | Male
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Dates
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Enumeration Date | 04/26/2008
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Last Update Date | 09/15/2010
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Provider Practice Location Address
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Address Line | 4540 KEARNY VILLA RD SUITE 218
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City | SAN DIEGO
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State | CA
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Zip | 92123-1571
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Country | US
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Telephone | 619-813-0315
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Fax |
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Provider Business Mailing Address
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Address Line | 4540 KEARNY VILLA RD SUITE 218
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City | SAN DIEGO
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State | CA
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Zip | 92123-1571
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Country | US
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Telephone | 619-813-0315
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFC 45318
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License Number State | CA
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