Provider Demographics
NPI:1538384367
Name:LETIZI, TERRY NA (MFT)
Entity type:Individual
Prefix:MS
First Name:TERRY
Middle Name:NA
Last Name:LETIZI
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 E COTATI AVE
Mailing Address - Street 2:STE. 245
Mailing Address - City:COTATI
Mailing Address - State:CA
Mailing Address - Zip Code:94931-4015
Mailing Address - Country:US
Mailing Address - Phone:707-548-5325
Mailing Address - Fax:707-792-2118
Practice Address - Street 1:525 E COTATI AVE
Practice Address - Street 2:STE. 245
Practice Address - City:COTATI
Practice Address - State:CA
Practice Address - Zip Code:94931-4015
Practice Address - Country:US
Practice Address - Phone:707-548-5325
Practice Address - Fax:707-792-2118
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2009-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 41058106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist