Provider Demographics
NPI:1689736803
Name:FALLETTI, JOHN LESLIE (MFT)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:LESLIE
Last Name:FALLETTI
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 1:10 INDEPENDENCE CIR
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95973-0381
Mailing Address - Country:US
Mailing Address - Phone:530-345-1600
Mailing Address - Fax:530-345-1685
Practice Address - Street 1:10 INDEPENDENCE CIRCLE
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95973
Practice Address - Country:US
Practice Address - Phone:530-345-1600
Practice Address - Fax:530-345-1685
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC28866106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist