Provider Demographics
NPI:1528325487
Name:TOMPKINS, PATRICK (LMFT)
Entity type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:
Last Name:TOMPKINS
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 402
Mailing Address - Street 2:
Mailing Address - City:SEAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90740-0402
Mailing Address - Country:US
Mailing Address - Phone:949-400-6435
Mailing Address - Fax:562-431-3525
Practice Address - Street 1:1670 SANTA ANA AVE
Practice Address - Street 2:SUITE N
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-3820
Practice Address - Country:US
Practice Address - Phone:949-400-6435
Practice Address - Fax:562-431-3523
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-17
Last Update Date:2012-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC48346106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist