Bridges to Self Empowerment a Marriage and Family Therapist Corporatio

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

MFC43967 Issued in CA

Legal business name

BRIDGES TO SELF EMPOWERMENT A MARRIAGE AND FAMILY THERAPIST CORPORATIO

Practice address

406 Chinn St
Santa Rosa, CA 95404-4339

Phone

(707) 495-5350

Fax

(707) 570-2680

NPI assigned

Jan 29, 2017

Organization subpart

Yes

Parent organization

BRIDGES TO SELF EMPOWERMENTAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Alice Dee Petty-Hannum, MFTNPI 1790989119

Title

Corporation Owner

Phone

(707) 495-5350

Specialties & licenses 1

Addresses

Other names 1

• Alice Petty-Hannum MFT Doing business as

Part of

Bridges to Self Empowerment a Marriage and Family Therapist Corporatio

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Alice D Petty-Hannum, MFT

  • Marriage & Family Therapist
  • Santa Rosa, CA
  • NPI 1790989119
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1485648000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1485648000000",
    "number": "1336686369",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "406 CHINN ST",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954044339",
            "telephone_number": "707-495-5350",
            "fax_number": "707-570-2680"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "406 CHINN ST",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954044339",
            "telephone_number": "707-495-5350",
            "fax_number": "707-570-2680"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRIDGES TO SELF EMPOWERMENT A MARRIAGE AND FAMILY THERAPIST CORPORATIO",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BRIDGES TO SELF EMPOWERMENT",
        "enumeration_date": "2017-01-29",
        "last_updated": "2017-01-29",
        "status": "A",
        "authorized_official_last_name": "PETTY-HANNUM",
        "authorized_official_first_name": "ALICE",
        "authorized_official_middle_name": "DEE",
        "authorized_official_title_or_position": "CORPORATION OWNER",
        "authorized_official_telephone_number": "707-495-5350",
        "authorized_official_credential": "MFT"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "CA",
            "license": "MFC43967",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Alice Petty-Hannum MFT",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Theresa Brewer
• Brian Thalhamer
• Danielle E Bricker
• Emelyn M Bricker
• Guthrie Bridge, CMT
• Ayla Beth Bridges, MS
• Jeffrey Keith Bridges, PH.D.
• Bridges, Pregnancy Clinic and Care Center, Inc.
• Brien a Seeley M.D., Inc
• Joanna Lee Briese

• Community/Behavioral Health Agency in Santa Rosa, CA
• Providers in Santa Rosa, CA by specialty
• Community/Behavioral Health Agency in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.