Provider Demographics
NPI:1366750259
Name:FOUGHTY, MARK
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:FOUGHTY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 DAILY DR
Mailing Address - Street 2:6
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-5836
Mailing Address - Country:US
Mailing Address - Phone:818-481-6289
Mailing Address - Fax:
Practice Address - Street 1:2055 SAVIERS RD
Practice Address - Street 2:SUITE 10
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93033-3608
Practice Address - Country:US
Practice Address - Phone:805-483-2253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-14
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)