Provider Demographics
NPI:1144547530
Name:REECE, CARLA MARCELLA (MFT)
Entity type:Individual
Prefix:MRS
First Name:CARLA
Middle Name:MARCELLA
Last Name:REECE
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:MISS
Other - First Name:CARLA
Other - Middle Name:MARCELLA
Other - Last Name:PANFIGLIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 7023
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94955-7023
Mailing Address - Country:US
Mailing Address - Phone:707-774-5778
Mailing Address - Fax:
Practice Address - Street 1:47 6TH ST STE 108
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-3092
Practice Address - Country:US
Practice Address - Phone:707-774-5778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-26
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
CALMFT101372106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselor