Provider Demographics
NPI:1144428053
Name:FLETCHER, PHEBE M (MFTI)
Entity Type:Individual
Prefix:MISS
First Name:PHEBE
Middle Name:M
Last Name:FLETCHER
Suffix:
Gender:F
Credentials:MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2762 ACTON ST
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94702-2334
Mailing Address - Country:US
Mailing Address - Phone:510-967-6267
Mailing Address - Fax:
Practice Address - Street 1:2762 ACTON ST
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94702-2334
Practice Address - Country:US
Practice Address - Phone:510-967-6267
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50647106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC1538368OtherCAL. DRIVERS LIC.