Provider Demographics
NPI:1861550436
Name:O'BRIEN, BETTINA M (MA, LMFT)
Entity type:Individual
Prefix:
First Name:BETTINA
Middle Name:M
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:865 3RD ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-4515
Mailing Address - Country:US
Mailing Address - Phone:707-583-2336
Mailing Address - Fax:
Practice Address - Street 1:865 3RD ST
Practice Address - Street 2:SUITE 102
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-4515
Practice Address - Country:US
Practice Address - Phone:707-583-2336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 40006106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist