Provider Demographics
NPI:1710073309
Name:WOOLLEY, MILTON HERMAN (MFT)
Entity Type:Individual
Prefix:MR
First Name:MILTON
Middle Name:HERMAN
Last Name:WOOLLEY
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 1:2608 PATIO CT
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-6924
Mailing Address - Country:US
Mailing Address - Phone:707-481-4343
Mailing Address - Fax:
Practice Address - Street 1:405 CHINN ST
Practice Address - Street 2:106
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-4309
Practice Address - Country:US
Practice Address - Phone:707-481-4343
Practice Address - Fax:707-566-7867
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC14417101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health