Healthcare Provider Details

I. General information

NPI: 1861818759
Provider Name (Legal Business Name): MARY CATHERINE HARPER MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MUNCIE HARPER MFT

II. Dates (important events)

Enumeration Date: 03/15/2014
Last Update Date: 08/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 COLLEGE AVE
SANTA ROSA CA
95404
US

IV. Provider business mailing address

1120 COLLEGE AVE
SANTA ROSA CA
95404-3906
US

V. Phone/Fax

Practice location:
  • Phone: 707-332-2758
  • Fax: 707-526-6458
Mailing address:
  • Phone: 707-332-2758
  • Fax: 707-526-6458

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number52053
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: