Provider Demographics
NPI:1508296989
Name:TAPESTRY FAMILY SERVICES
Entity Type:Organization
Organization Name:TAPESTRY FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:JENNIFER
Authorized Official - Last Name:JOHNS
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:707-463-3300
Mailing Address - Street 1:290 E GOBBI ST
Mailing Address - Street 2:
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-5559
Mailing Address - Country:US
Mailing Address - Phone:707-463-3300
Mailing Address - Fax:707-463-3318
Practice Address - Street 1:1011 LOW GAP ROAD
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482
Practice Address - Country:US
Practice Address - Phone:707-463-3300
Practice Address - Fax:707-463-3318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-20
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health