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NPI Code Detail

MEDICARE: BLANCA ESTELA PENA

MEDICARE: BLANCA ESTELA PENA
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
1101Y00000XCounselor114429CA
2101YM0800XMental Health Counselor
3171M00000XCase Manager/Care Coordinator114429CA
4225C00000XRehabilitation Counselor114429CA
5106H00000XMarriage & Family Therapist138765CA

General Provider Information

NPI Number : 1801308747
Entity Type Code : Individual
Provider Name (Legal Business Name) : BLANCA ESTELA PENA
Provider Business Mailing Address
First Line : 875 S ORCHARD AVE APT 4
Second Line :
City : UKIAH
State : CA
Zip : 95482-7448
Country : US
Telephone Number : 415-583-7564
Fax Number :
Provider Business Practice Location Address
First Line : 516 CYPRESS ST
Second Line :
City : FORT BRAGG
State : CA
Zip : 95437-5410
Country : US
Telephone Number : 415-583-7564
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/01/2017
Last Update Date : 11/12/2024

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Directions to “ BLANCA ESTELA PENA ” Practice Location

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