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General NPI Number Information
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NPI Number | 1710073309
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Entity Type | Individual
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Provider Name | MILTON HERMAN WOOLLEY M.F.T
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Gender | Male
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 405 CHINN ST 106
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City | SANTA ROSA
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State | CA
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Zip | 95404-4309
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Country | US
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Telephone | 707-481-4343
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Fax | 707-566-7867
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Provider Business Mailing Address
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Address Line | 2608 PATIO CT
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City | SANTA ROSA
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State | CA
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Zip | 95405-6924
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Country | US
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Telephone | 707-481-4343
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MFC14417
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License Number State | CA
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