Healthcare Provider Details

I. General information

NPI: 1750975470
Provider Name (Legal Business Name): MIMI ZATUCHNI LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2021
Last Update Date: 10/20/2025
Certification Date: 10/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

159 KENTUCKY ST STE 3
PETALUMA CA
94952-2324
US

IV. Provider business mailing address

159 KENTUCKY ST STE 3
PETALUMA CA
94952-2324
US

V. Phone/Fax

Practice location:
  • Phone: 707-665-1652
  • Fax:
Mailing address:
  • Phone: 707-665-1652
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number148974
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: