Provider Demographics
NPI:1124234281
Name:FRANKLIN, RICHARD PETTY (MFT)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:PETTY
Last Name:FRANKLIN
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 1:19425-B-SOLEDAD CYN. RD. #426
Mailing Address - Street 2:
Mailing Address - City:CANYON COUNTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91351-2664
Mailing Address - Country:US
Mailing Address - Phone:661-733-2603
Mailing Address - Fax:
Practice Address - Street 1:20200 DELIGHT ST
Practice Address - Street 2:
Practice Address - City:CANYON COUNTRY
Practice Address - State:CA
Practice Address - Zip Code:91351-2510
Practice Address - Country:US
Practice Address - Phone:661-733-2603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMCF41725106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAEPS016860OtherMEDI-CAL PROVIDER NO.