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NPI Code Detail

MEDICARE: MRS. CHANEL WITTMERSHAUS

MEDICARE: MRS. CHANEL WITTMERSHAUS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family Therapist

General Provider Information

NPI Number : 1790116879
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. CHANEL WITTMERSHAUS
Provider Business Mailing Address
First Line : PO BOX 2587
Second Line :
City : SANTA ROSA
State : CA
Zip : 95405-0587
Country : US
Telephone Number : 707-571-2215
Fax Number :
Provider Business Practice Location Address
First Line : 540 MIDDLE RINCON RD
Second Line :
City : SANTA ROSA
State : CA
Zip : 95409-3107
Country : US
Telephone Number : 707-571-2215
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/27/2013
Last Update Date : 11/27/2013

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Directions to “ MRS. CHANEL WITTMERSHAUS ” Practice Location

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