NPIMap

Organization Active NPI

TLC Child and Family Services

  • Adolescent and Children Mental Health Clinic/Center
  • Sebastopol, CA
National Provider Identifier
1639226814
Registry record updated Mar 3, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adolescent and Children Mental Health Clinic/CenterTaxonomy code 261QM0855X
Legal business name
TLC CHILD AND FAMILY SERVICES
Practice address
1800 Gravenstein Hwy N
BLDG a - E
Sebastopol, CA 95472-2607
Phone
(707) 823-7300
Fax
(707) 823-3410
NPI assigned
Jan 3, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 3, 2021

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

Authorized official

Name
Susan Fette, MFTNPI 1639516198
Title
Ceo
Phone
(707) 634-9932

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adolescent and Children Mental Health Clinic/Center 261QM0855X Primary

Addresses

Primary practice location

1800 Gravenstein Hwy N
BLDG a - E
Sebastopol, CA 95472-2607

Mailing address

1800 Gravenstein Hwy N
Suite a
Sebastopol, CA 95472-2607
Phone (707) 823-7300

Other names 1

  • TLC Child and Family Services Former legal business name

National Provider Directory

National Provider Directory
Tax ID family
TLC Child and Family Services2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 2

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

NPI Registry JSON

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

{
    "created_epoch": "1167782400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1614729600000",
    "number": "1639226814",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1800 GRAVENSTEIN HWY N",
            "address_2": "SUITE A",
            "city": "SEBASTOPOL",
            "state": "CA",
            "postal_code": "954722607",
            "telephone_number": "707-823-7300",
            "fax_number": "707-823-3410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1800 GRAVENSTEIN HWY N",
            "address_2": "BLDG A - E",
            "city": "SEBASTOPOL",
            "state": "CA",
            "postal_code": "954722607",
            "telephone_number": "707-823-7300",
            "fax_number": "707-823-3410"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TLC CHILD AND FAMILY SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-03",
        "last_updated": "2021-03-03",
        "certification_date": "2021-03-03",
        "status": "A",
        "authorized_official_last_name": "FETTE",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "707-634-9932",
        "authorized_official_credential": "MFT"
    },
    "taxonomies": [
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "TLC Child and Family Services",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "TLC Child and Family Services",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Sebastopol, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2021; 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.