| Doctor Name: | DR. DOUGLAS SLAKEY |
| NPI Number: | 1033595681 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PHD |
| License Number: | PSB94021750 |
| Business Practice Address: | 610 Elm St Suite 212 San Carlos, CA - 940708401 |
| Business Phone Number: | 6505919623 |
| Business Fax Number: | 6505919750 |
| Mailing Address: | 610 Elm St, Suite 212 SAN CARLOS |
| State: | CA |
| Postal Code: | 940708401 |
| Phone Number: | 6505919623 |
| Fax Number: | 6505919750 |
| NPI Enumeration Date: | 08/05/2015 |
| NPI Last Update Date: | 08/05/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | PSB94021750 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |