Douglas W Rolly, LMFT
Individual provider Active NPI Marriage & Family Therapist · Weed, CA
NPI 1629100276 · NPPES record last updated Jul 14, 2022
Key facts
- NPI
- 1629100276
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Marriage & Family Therapist 106H00000X
- License
- LMFT36040 (CA)
- Practice address
- 616 S Weed Blvd
Weed, CA 96094 - Phone
- (530) 859-3664
- Fax
- (559) 228-1106
- NPI assigned
- Mar 9, 2007
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LMFT36040 | CA | MD | Marriage & Family Therapist |
| MFC 36040 | CA | MD | Marriage & Family Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | LMFT36040 | CA | Yes |
| Marriage & Family Therapist | 106H00000X | MFC 36040 | CA |
Addresses
Primary practice location
616 S Weed Blvd
Weed, CA 96094
Mailing address
PO Box 116
Weed, CA 96094
Phone (530) 859-3664
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- David Rodriguez
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All providers in Weed, CA · Marriage & Family Therapist in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 14, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.