Healthcare Provider Details

I. General information

NPI: 1669590451
Provider Name (Legal Business Name): CALIFORNIA PARENTING INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 12/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3650 STANDISH AVE
SANTA ROSA CA
95407
US

IV. Provider business mailing address

3650 STANDISH AVE
SANTA ROSA CA
95407-8113
US

V. Phone/Fax

Practice location:
  • Phone: 707-585-6108
  • Fax: 707-585-2158
Mailing address:
  • Phone: 707-585-6108
  • Fax: 707-585-2158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. AUDREY E BOGGS
Title or Position: CLINIC DIRECTOR
Credential: PSY, D.
Phone: 707-585-6108