Active NPI
Thea A. Privette, MA, MFTI
- Marriage & Family Therapist
- Santa Rosa, CA
National Provider Identifier
1932629656
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 100934
- Practice address
- 3436 Mendocino Ave Ste a
Santa Rosa, CA 95403-2180 - Phone
- (707) 495-0367
- NPI assigned
- Jun 23, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | |||
| Mental Health Counselor | 101YM0800X | 100934 | CA | |
| Marriage & Family Therapist | 106H00000X | 100934 | CA | Primary |
Addresses
Primary practice location
3436 Mendocino Ave Ste a
Santa Rosa, CA 95403-2180
Mailing address
2777 Yulupa Ave Ste 298
Santa Rosa, CA 95405-8584
Phone (707) 495-0367
Other practice location 1
2275 Arlington Dr
San Leandro, CA 94578-1132
Phone (510) 317-1444
Medicare participation
Medicare enrollment files- 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
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 100934 | CA | MD | Oral and Maxillofacial Surgery (Dentist) |
| 124467 | CA | MD | Pharmacy Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1498176000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1623110400000",
"number": "1932629656",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2777 YULUPA AVE STE 298",
"city": "SANTA ROSA",
"state": "CA",
"postal_code": "954058584",
"telephone_number": "707-495-0367"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3436 MENDOCINO AVE STE A",
"city": "SANTA ROSA",
"state": "CA",
"postal_code": "954032180",
"telephone_number": "707-495-0367"
}
],
"practiceLocations": [
{
"address_1": "2275 Arlington Dr",
"address_purpose": "LOCATION",
"city": "San Leandro",
"state": "CA",
"postal_code": "945781132",
"country_code": "US",
"telephone_number": "510-317-1444",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "PRIVETTE",
"first_name": "THEA",
"middle_name": "A.",
"credential": "MA, MFTI",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-06-23",
"last_updated": "2021-06-08",
"certification_date": "2021-06-08",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": null,
"license": null,
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "CA",
"license": "100934",
"primary": false
},
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "100934",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Santa Rosa, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2021; 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.