Healthcare Provider Details

I. General information

NPI: 1497035869
Provider Name (Legal Business Name): PENNE MICHELLE LARUE-RADER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2011
Last Update Date: 07/18/2025
Certification Date: 07/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

578 RIO LINDO AVE
CHICO CA
95926-1800
US

IV. Provider business mailing address

25885 SANTA ROSA RD 25885 SANTA ROSA RD
APPLE VALLEY CA
92308-1800
US

V. Phone/Fax

Practice location:
  • Phone: 530-894-5933
  • Fax: 530-894-5791
Mailing address:
  • Phone: 530-443-3828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number99159
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number75675
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: