Provider Demographics
NPI:1699941633
Name:SIDDONS, RAYMOND J (MFT)
Entity type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:J
Last Name:SIDDONS
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5805 CAPISTRANO AVE STE H
Mailing Address - Street 2:
Mailing Address - City:ATASCADERO
Mailing Address - State:CA
Mailing Address - Zip Code:93422-7218
Mailing Address - Country:US
Mailing Address - Phone:805-792-2873
Mailing Address - Fax:805-466-0742
Practice Address - Street 1:5805 CAPISTRANO AVE STE H
Practice Address - Street 2:
Practice Address - City:ATASCADERO
Practice Address - State:CA
Practice Address - Zip Code:93422-7218
Practice Address - Country:US
Practice Address - Phone:805-792-2873
Practice Address - Fax:805-466-0742
Is Sole Proprietor?:No
Enumeration Date:2008-04-30
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT14939106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALMFT14939OtherLICENSE