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General NPI Number Information
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NPI Number | 1871238311
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Entity Type | Organization
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Legal Business Name | ANN STRACK, PH.D.
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Dates
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Enumeration Date | 04/29/2022
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Last Update Date | 04/29/2022
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Provider Practice Location Address
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Address Line | 318 WESTERN AVE
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City | PETALUMA
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State | CA
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Zip | 94952-2919
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Country | US
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Telephone | 707-762-6216
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Fax |
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Provider Business Mailing Address
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Address Line | 318 WESTERN AVE
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City | PETALUMA
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State | CA
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Zip | 94952-2919
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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 | OWNER
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Name | ANNETTE STRACK
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Credential |
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Telephone | 707-762-6216
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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