| Perseverant Mind Therapy | |
|
131a Stony Circle Suite #500 Santa Rosa CA 95401 | |
| (707) 238-2072 | |
| Not Available |
| Full Name | Perseverant Mind Therapy |
|---|---|
| Speciality | Social Worker |
| Location | 131a Stony Circle, Santa Rosa, California |
| Authorized Official Name and Position | Elisa Villafana (CLINICAL DIRECTOR) |
| Authorized Official Contact | 7072382072 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Perseverant Mind Therapy 131a Stony Cir Ste 500 Santa Rosa CA 95401-9600 Ph: () - | Perseverant Mind Therapy 131a Stony Circle Suite #500 Santa Rosa CA 95401 Ph: (707) 238-2072 |
| NPI Number | 1598413403 |
|---|---|
| Provider Enumeration Date | 03/10/2022 |
| Last Update Date | 11/20/2023 |
| Certification Date | 11/20/2023 |
| Medicare PECOS PAC ID | 2365823184 |
|---|---|
| Medicare Enrollment ID | O20220725002233 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598413403 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Elisa Jimenez Villafana |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1700350931 PECOS PAC ID: 9133532666 Enrollment ID: I20201230001644 |
| Provider Name | Muang Chiem Kistler |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1023368669 PECOS PAC ID: 8022488204 Enrollment ID: I20230130001572 |
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