Healthcare Provider Details

I. General information

NPI: 1073303202
Provider Name (Legal Business Name): TODD HARLAND BELLINGER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2025
Last Update Date: 05/09/2025
Certification Date: 05/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2225 CHALLENGER WAY
SANTA ROSA CA
95407-5441
US

IV. Provider business mailing address

PO BOX 618
SAN GERONIMO CA
94963-0618
US

V. Phone/Fax

Practice location:
  • Phone: 707-565-4970
  • Fax: 707-565-5183
Mailing address:
  • Phone: 707-292-3926
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number141907
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: