Healthcare Provider Details

I. General information

NPI: 1659447407
Provider Name (Legal Business Name): JUDITH BLACKBIRD JOINVILLE LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/24/2006
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

328 SPRINGDALE ST
SEBASTOPOL CA
95472-3253
US

IV. Provider business mailing address

PO BOX 960
SEBASTOPOL CA
95473-0960
US

V. Phone/Fax

Practice location:
  • Phone: 707-775-1281
  • Fax:
Mailing address:
  • Phone: 707-775-1281
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT31799
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: