Provider Demographics
NPI:1063598340
Name:MARKLE, DONALD P (MFT)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:P
Last Name:MARKLE
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:687 HARBOR CV
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95062-2756
Mailing Address - Country:US
Mailing Address - Phone:831-476-5060
Mailing Address - Fax:831-476-0356
Practice Address - Street 1:38750 PASEO PADRE PKWY
Practice Address - Street 2:A9
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94536-6135
Practice Address - Country:US
Practice Address - Phone:510-794-0772
Practice Address - Fax:510-742-0307
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC8611106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA943012950OtherEMPLOYER IDENTIFICATION