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General NPI Number Information
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NPI Number | 1841735669
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Entity Type | Organization
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Legal Business Name | VACAVILLE MUSIC THERAPY
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Dates
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Enumeration Date | 01/03/2017
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Last Update Date | 01/03/2017
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Provider Practice Location Address
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Address Line | 183 BUTCHER RD SUITE B
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City | VACAVILLE
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State | CA
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Zip | 95687-5690
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Country | US
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Telephone | 707-718-1103
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Fax |
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Provider Business Mailing Address
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Address Line | 255 ALDER CREST WAY
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City | VACAVILLE
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State | CA
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Zip | 95688-9266
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Country | US
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Telephone | 707-718-1103
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Fax |
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Authorized Official
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Title or Position | OWNER/DIRECTOR
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Name | MRS. BRIANNA MARIE MCCULLOCH
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Credential | MM, MT-BC
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Telephone | 707-718-1103
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225A00000X
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Taxonomy Name | Music Therapist
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License Number |
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License Number State |
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