Healthcare Provider Details

I. General information

NPI: 1316870918
Provider Name (Legal Business Name): FORGED IN FIRE FAMILY THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

237 YATELEY DR
VACAVILLE CA
95687-7953
US

IV. Provider business mailing address

237 YATELEY DR
VACAVILLE CA
95687-7953
US

V. Phone/Fax

Practice location:
  • Phone: 530-688-6875
  • Fax:
Mailing address:
  • Phone: 530-688-6875
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MEAGAN PHAM MIELKE
Title or Position: CEO
Credential: LMFT
Phone: 530-688-6875