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General NPI Number Information
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NPI Number | 1356733257
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Entity Type | Organization
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Legal Business Name | PETER SHOLLEY MFT
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Dates
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Enumeration Date | 03/02/2015
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Last Update Date | 03/02/2015
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Provider Practice Location Address
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Address Line | 651 CHERRY ST
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City | SANTA ROSA
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State | CA
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Zip | 95404-4202
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Country | US
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Telephone | 415-820-3969
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Fax |
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Provider Business Mailing Address
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Address Line | 779 SUMMERFIELD RD
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City | SANTA ROSA
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State | CA
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Zip | 95405-7103
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PSYCHOTHERAPIST
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Name | MR. PETER N SHOLLEY
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Credential | MA, MFT
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Telephone | 415-820-3969
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | MFCC# 53511
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License Number State | CA
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