| Full Heart Treatment Center | |
|
606 Beaver St Santa Rosa CA 95404-4228 | |
| (707) 544-5717 | |
| (707) 887-8288 |
| Full Name | Full Heart Treatment Center |
|---|---|
| Speciality | Marriage & Family Therapist |
| Location | 606 Beaver St, Santa Rosa, California |
| Authorized Official Name and Position | William J Formaker (OWNER) |
| Authorized Official Contact | 7075445717 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Full Heart Treatment Center 606 Beaver St Santa Rosa CA 95404-4228 Ph: (707) 544-5717 | Full Heart Treatment Center 606 Beaver St Santa Rosa CA 95404-4228 Ph: (707) 544-5717 |
| NPI Number | 1841605961 |
|---|---|
| Provider Enumeration Date | 06/26/2014 |
| Last Update Date | 06/26/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841605961 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 106H00000X | Marriage & Family Therapist | MFT29030 (California) | Primary |
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