Provider Demographics
NPI:1356854673
Name:SONOMA THERAPY NETWORK
Entity Type:Organization
Organization Name:SONOMA THERAPY NETWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GARET
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:WATERHOUSE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:707-387-4525
Mailing Address - Street 1:3438 MENDOCINO AVE STE B
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-2275
Mailing Address - Country:US
Mailing Address - Phone:707-387-4525
Mailing Address - Fax:707-861-9292
Practice Address - Street 1:3438 MENDOCINO AVE STE B
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-2275
Practice Address - Country:US
Practice Address - Phone:707-387-4525
Practice Address - Fax:707-843-5574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-08
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)