Healthcare Provider Details

I. General information

NPI: 1720292568
Provider Name (Legal Business Name): ROBERT ALEXANDER VILLARREAL LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 01/19/2022
Certification Date: 01/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

137 N COTTONWOOD ST
WOODLAND CA
95695-6646
US

IV. Provider business mailing address

137 N COTTONWOOD ST
WOODLAND CA
95695-6646
US

V. Phone/Fax

Practice location:
  • Phone: 530-666-8630
  • Fax:
Mailing address:
  • Phone: 530-666-8630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPT28111
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number69112
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number104386
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: