Healthcare Provider Details

I. General information

NPI: 1124946892
Provider Name (Legal Business Name): TARA LANATTI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1035 STAGE GULCH RD
PETALUMA CA
94954-9550
US

IV. Provider business mailing address

1035 STAGE GULCH RD
PETALUMA CA
94954-9550
US

V. Phone/Fax

Practice location:
  • Phone: 707-775-8870
  • Fax:
Mailing address:
  • Phone: 707-775-8870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: