Healthcare Provider Details

I. General information

NPI: 1831828649
Provider Name (Legal Business Name): EMILY KATHLEEN EMMERSON AMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2022
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

651 CHERRY ST
SANTA ROSA CA
95404-4202
US

IV. Provider business mailing address

2751 4TH ST # 133
SANTA ROSA CA
95405-4726
US

V. Phone/Fax

Practice location:
  • Phone: 415-609-5887
  • Fax:
Mailing address:
  • Phone: 707-494-4660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number140473
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: