Provider Demographics
NPI:1104855873
Name:PEHLE, CECILIA HOBBIE (MFT)
Entity Type:Individual
Prefix:MS
First Name:CECILIA
Middle Name:HOBBIE
Last Name:PEHLE
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3412 JOHN LEE LN
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-0926
Mailing Address - Country:US
Mailing Address - Phone:209-577-1159
Mailing Address - Fax:209-823-8189
Practice Address - Street 1:965 E YOSEMITE AVE
Practice Address - Street 2:EXECUTIVE PLAZA SUITE 12
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95336-5938
Practice Address - Country:US
Practice Address - Phone:209-577-1159
Practice Address - Fax:209-823-8189
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC21745106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist