Healthcare Provider Details

I. General information

NPI: 1841735669
Provider Name (Legal Business Name): VACAVILLE MUSIC THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2017
Last Update Date: 01/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

183 BUTCHER RD SUITE B
VACAVILLE CA
95687-5690
US

IV. Provider business mailing address

255 ALDER CREST WAY
VACAVILLE CA
95688-9266
US

V. Phone/Fax

Practice location:
  • Phone: 707-718-1103
  • Fax:
Mailing address:
  • Phone: 707-718-1103
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number
License Number State

VIII. Authorized Official

Name: MRS. BRIANNA MARIE MCCULLOCH
Title or Position: OWNER/DIRECTOR
Credential: MM, MT-BC
Phone: 707-718-1103