Provider Demographics
NPI:1356506778
Name:TROWBRIDGE, JASON (MFT)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:
Last Name:TROWBRIDGE
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 3RD ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-4502
Mailing Address - Country:US
Mailing Address - Phone:707-849-7032
Mailing Address - Fax:707-545-6698
Practice Address - Street 1:840 3RD ST
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-4502
Practice Address - Country:US
Practice Address - Phone:707-849-7032
Practice Address - Fax:707-545-6698
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-24
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42007106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist