Alice D Petty-Hannum, MFT

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

43967 Issued in CA

Practice address

406 Chinn St
Santa Rosa, CA 95404-4339

Phone

(707) 495-5350

Fax

(707) 570-2680

NPI assigned

Jun 11, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Alice D Petty Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Jan 1, 2024 through Jan 1, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Bridges to Self Empowerment a Marriage and Family Therapist Corporatio

  • Community/Behavioral Health Agency
  • Santa Rosa, CA
  • NPI 1336686369
  NPD (past) Authorized official

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

{
    "created_epoch": "1181520000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1314230400000",
    "number": "1790989119",
    "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": {
        "last_name": "PETTY-HANNUM",
        "first_name": "ALICE",
        "middle_name": "D",
        "credential": "MFT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-06-11",
        "last_updated": "2011-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "43967",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ALICE",
            "last_name": "PETTY",
            "middle_name": "D",
            "credential": "MFT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Sherrill Diane Petherbridge, FNP
• Parker William Petray
• Maria M. Petrick, M.D.
• Katherine Pettibone, DPM
• Jill Pettit, CCC-SLP
• Joseph Michael Petzel, M.F.T.
• Michael Leonce Pezold, M.D.
• Christina Catherine Pfeifer
• Angela Bizzarri Pflugrath, DO
• Matthew Pfohl-Smith, RASI

• Marriage & Family Therapist in Santa Rosa, CA
• Providers in Santa Rosa, CA by specialty
• Marriage & Family Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.