Healthcare Provider Details

I. General information

NPI: 1154537207
Provider Name (Legal Business Name): ANGELA RENEE WURTZEL M.A., M.F.T
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 E VICTORIA ST REAR COTTAGE
SANTA BARBARA CA
93101-2619
US

IV. Provider business mailing address

27 E VICTORIA ST REAR COTTAGE
SANTA BARBARA CA
93101-2619
US

V. Phone/Fax

Practice location:
  • Phone: 805-884-9794
  • Fax: 805-884-9794
Mailing address:
  • Phone: 805-884-9794
  • Fax: 805-884-9794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number33686
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: