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General NPI Number Information
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NPI Number | 1346420320
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Entity Type | Organization
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Legal Business Name | RISKIN BANKER PSYCHOTHERAPY
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Dates
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Enumeration Date | 11/07/2007
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Last Update Date | 11/07/2007
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Provider Practice Location Address
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Address Line | 1913 E 17TH ST STE 107
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City | SANTA ANA
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State | CA
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Zip | 92705-8627
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Country | US
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Telephone | 714-953-9882
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Fax | 714-953-2094
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Provider Business Mailing Address
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Address Line | 1913 E 17TH ST STE 107
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City | SANTA ANA
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State | CA
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Zip | 92705-8627
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Country | US
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Telephone | 714-953-9882
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Fax | 714-953-2094
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. MICHAEL RISKIN
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Credential | PHD
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Telephone | 714-953-9882
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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 | MFC8768
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License Number State | CA
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