Provider Demographics
NPI:1053302687
Name:HALLENBECK, PATRICIA D (MFT)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:D
Last Name:HALLENBECK
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:TRISH
Other - Middle Name:
Other - Last Name:HALLENBECK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MFT
Mailing Address - Street 1:159 KENTUCKY ST
Mailing Address - Street 2:STE 10
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952-2305
Mailing Address - Country:US
Mailing Address - Phone:707-769-1461
Mailing Address - Fax:
Practice Address - Street 1:159 KENTUCKY ST
Practice Address - Street 2:STE 10
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-2305
Practice Address - Country:US
Practice Address - Phone:707-769-1461
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC26017106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist