Healthcare Provider Details

I. General information

NPI: 1700645355
Provider Name (Legal Business Name): HELENA TIETZE AMFT, APCC, MT-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2024
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

327 COLLEGE AVE
SANTA ROSA CA
95401-5117
US

IV. Provider business mailing address

655 IRWIN ST STE B #1061
SAN RAFAEL CA
94901-4073
US

V. Phone/Fax

Practice location:
  • Phone: 707-568-2800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAPCC21662
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT158888
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number17926
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: