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General NPI Number Information
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NPI Number | 1649081316
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Entity Type | Individual
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Provider Name | PHOEBE A MCKINNEY MFT TRAINEE
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Gender | Female
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Dates
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Enumeration Date | 01/14/2025
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Last Update Date | 01/14/2025
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Provider Practice Location Address
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Address Line | 320 10TH ST STE 200
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City | SANTA ROSA
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State | CA
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Zip | 95401-5291
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Country | US
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Telephone | 707-579-0465
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Fax |
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Provider Business Mailing Address
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Address Line | 4273 SANTA RITA RD
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City | EL SOBRANTE
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State | CA
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Zip | 94803-2306
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Country | US
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Telephone | 510-356-7272
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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