Healthcare Provider Details

I. General information

NPI: 1053651976
Provider Name (Legal Business Name): MALLORY ELISA PENZOTTI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2013
Last Update Date: 01/22/2021
Certification Date: 01/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 W 6TH ST
CHICO CA
95928-5508
US

IV. Provider business mailing address

130 W 6TH ST
CHICO CA
95928-5508
US

V. Phone/Fax

Practice location:
  • Phone: 530-894-8008
  • Fax: 530-894-5791
Mailing address:
  • Phone: 530-894-8008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: