Provider Demographics
NPI:1396853354
Name:MUTINDA, PEGGY W (MFT)
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:W
Last Name:MUTINDA
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3650-A AUBURN BOULEVARD,
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95821-4472
Mailing Address - Country:US
Mailing Address - Phone:916-607-7698
Mailing Address - Fax:916-973-1047
Practice Address - Street 1:3650-A AUBURN BOULEVARD,
Practice Address - Street 2:SUITE 200
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95821-4472
Practice Address - Country:US
Practice Address - Phone:916-607-7698
Practice Address - Fax:916-973-1047
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 42412106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist