Provider Demographics
NPI:1366560559
Name:SALTOUN, MYRA D (PHD)
Entity type:Individual
Prefix:DR
First Name:MYRA
Middle Name:D
Last Name:SALTOUN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:MYRA
Other - Middle Name:
Other - Last Name:SALTOUN-MORAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:3585 MAPLE ST STE 150
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-9115
Mailing Address - Country:US
Mailing Address - Phone:805-644-9884
Mailing Address - Fax:
Practice Address - Street 1:3585 MAPLE ST STE 150
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-9115
Practice Address - Country:US
Practice Address - Phone:805-644-9884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY10486103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical