Healthcare Provider Details

I. General information

NPI: 1063927713
Provider Name (Legal Business Name): TENAYA L PERINE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2017
Last Update Date: 12/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1421 GUERNEVILLE RD
SANTA ROSA CA
95403-7220
US

IV. Provider business mailing address

1421 GUERNEVILLE RD STE 228
SANTA ROSA CA
95403-7243
US

V. Phone/Fax

Practice location:
  • Phone: 707-576-7700
  • Fax:
Mailing address:
  • Phone: 707-576-7700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: