=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265568984
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ST. CLAIR PATRICK ALEXANDER M.S., PHD., LMFT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/26/2007
-----------------------------------------------------
Last Update Date | 12/21/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13800 HEACOCK STREET
-----------------------------------------------------
City | MORENO VALLEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92553
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-503-3475
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13800 HEACOCK STREET
-----------------------------------------------------
City | MORENO VALLEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92553
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-503-3475
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | LMFT87669
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------