Provider Demographics
NPI:1285774547
Name:RUNDELL, DEBRA JOYCE (MFT)
Entity type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:JOYCE
Last Name:RUNDELL
Suffix:
Gender:F
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:P.O. BOX 154
Mailing Address - Street 2:
Mailing Address - City:LAKE ISABELLA
Mailing Address - State:CA
Mailing Address - Zip Code:93240
Mailing Address - Country:US
Mailing Address - Phone:760-417-0309
Mailing Address - Fax:760-379-3835
Practice Address - Street 1:5408 LAKE ISABELLA BLVD.
Practice Address - Street 2:
Practice Address - City:LAKE ISABELLA
Practice Address - State:CA
Practice Address - Zip Code:93240-2731
Practice Address - Country:US
Practice Address - Phone:760-417-0309
Practice Address - Fax:760-379-3835
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2009-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 39299106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist