Provider Demographics
NPI:1316386352
Name:SPATH, TODD LELAND (MA)
Entity type:Individual
Prefix:MR
First Name:TODD
Middle Name:LELAND
Last Name:SPATH
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1532 CLIFFTOP AVE
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-1075
Mailing Address - Country:US
Mailing Address - Phone:760-717-8706
Mailing Address - Fax:
Practice Address - Street 1:130 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-2614
Practice Address - Country:US
Practice Address - Phone:760-745-7732
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-24
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 52647106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist