Provider Demographics
NPI:1225311053
Name:MORALES-PETRIE, DEBBIE (MS, LMFT)
Entity Type:Individual
Prefix:
First Name:DEBBIE
Middle Name:
Last Name:MORALES-PETRIE
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 785
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95678-0785
Mailing Address - Country:US
Mailing Address - Phone:415-990-3685
Mailing Address - Fax:
Practice Address - Street 1:720 SUNRISE AVE STE 115D
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-4509
Practice Address - Country:US
Practice Address - Phone:415-990-3685
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-28
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT 81604106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist