Individual
WILLIAM WADE MIDDLETON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPT/PET CLINICIAN
Contact information
Practice address
3630 E IMPERIAL HWY, LYNWOOD, CA 90262-2609
(301) 900-8210
(310) 900-8286
Mailing address
919 OLIVE AVE, HUNTINGTON BEACH, CA 92648-4809
(714) 591-3856
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
PT26958
CA
167G00000X
Licensed Psychiatric Technician
Primary
PT26958
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1245227180
—
CA
01
—
167G00000X
ADDTAXONMY
CA
Enumeration date
06/04/2015
Last updated
08/28/2019
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