| Relationship Center For Change A Marriage And Family Therapy Pc | |
|
2455 Bennett Valley Rd Ste C210 Santa Rosa CA 95404-5671 | |
| (707) 523-8009 | |
| Not Available |
| Full Name | Relationship Center For Change A Marriage And Family Therapy Pc |
|---|---|
| Speciality | Marriage & Family Therapist |
| Location | 2455 Bennett Valley Rd Ste C210, Santa Rosa, California |
| Authorized Official Name and Position | Robert Butler (VICE PRESIDENT) |
| Authorized Official Contact | 7075238009 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Relationship Center For Change A Marriage And Family Therapy Pc 40 4th St #224 Petaluma CA 94952-3040 Ph: (707) 523-8009 | Relationship Center For Change A Marriage And Family Therapy Pc 2455 Bennett Valley Rd Ste C210 Santa Rosa CA 95404-5671 Ph: (707) 523-8009 |
| NPI Number | 1689014615 |
|---|---|
| Provider Enumeration Date | 07/05/2013 |
| Last Update Date | 06/30/2023 |
| Certification Date | 06/19/2023 |
| Medicare PECOS PAC ID | 2466693726 |
|---|---|
| Medicare Enrollment ID | O20130729000762 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689014615 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Secondary |
| 106H00000X | Marriage & Family Therapist | (* (Not Available)) | Primary |
| Provider Name | Robert O Butler |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1093718454 PECOS PAC ID: 8527002724 Enrollment ID: I20050617001007 |
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