Provider Demographics
NPI:1407913601
Name:PETZEL, JOSEPH MICHAEL (MFT)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:MICHAEL
Last Name:PETZEL
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 1:751 LOMBARDI CT
Mailing Address - Street 2:SUITE C
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95407-6793
Mailing Address - Country:US
Mailing Address - Phone:707-545-4551
Mailing Address - Fax:707-545-4590
Practice Address - Street 1:751 LOMBARDI CT
Practice Address - Street 2:SUITE C
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95407-6793
Practice Address - Country:US
Practice Address - Phone:707-545-4551
Practice Address - Fax:707-545-4590
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT 25765101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health