Provider Demographics
NPI:1568295053
Name:FENSTERMAKER, TOM (COUNSELOR)
Entity type:Individual
Prefix:
First Name:TOM
Middle Name:
Last Name:FENSTERMAKER
Suffix:
Gender:M
Credentials:COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:565 MONTEREY AVE
Mailing Address - Street 2:
Mailing Address - City:MORRO BAY
Mailing Address - State:CA
Mailing Address - Zip Code:93442-2257
Mailing Address - Country:US
Mailing Address - Phone:805-888-1828
Mailing Address - Fax:
Practice Address - Street 1:565 MONTEREY AVE
Practice Address - Street 2:
Practice Address - City:MORRO BAY
Practice Address - State:CA
Practice Address - Zip Code:93442-2257
Practice Address - Country:US
Practice Address - Phone:805-888-1828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-21
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty