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General NPI Number Information
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NPI Number | 1831207489
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Entity Type | Individual
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Provider Name | RICHARD GEORGE MYATT LMFT
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Gender | Male
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Dates
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Enumeration Date | 08/25/2006
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Last Update Date | 06/22/2021
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Provider Practice Location Address
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Address Line | 17133 ARROW BLVD STE A
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City | FONTANA
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State | CA
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Zip | 92335-4051
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Country | US
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Telephone | 909-251-4654
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Fax | 909-365-4086
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Provider Business Mailing Address
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Address Line | 966 BIDWELL RD
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City | SAN DIMAS
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State | CA
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Zip | 91773-1566
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Country | US
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Telephone | 626-524-2152
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Fax | 909-365-4086
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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 | MFT 33223
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License Number State | CA
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