Provider Demographics
NPI:1366063372
Name:COUTO, CHRISTIAN E (RADT)
Entity type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:E
Last Name:COUTO
Suffix:
Gender:M
Credentials:RADT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12183 LOCKSLEY LN STE 101
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95602-2050
Mailing Address - Country:US
Mailing Address - Phone:530-885-1961
Mailing Address - Fax:530-886-1304
Practice Address - Street 1:12183 LOCKSLEY LN STE 101
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95602-2050
Practice Address - Country:US
Practice Address - Phone:530-885-1961
Practice Address - Fax:530-886-1304
Is Sole Proprietor?:No
Enumeration Date:2020-04-30
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1390440520101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)