Provider Demographics
NPI:1821133190
Name:PARNELL, PEGGY ANNE (MFT INTERN)
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:ANNE
Last Name:PARNELL
Suffix:
Gender:F
Credentials:MFT INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1624 JOAN DR
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94954-3657
Mailing Address - Country:US
Mailing Address - Phone:707-206-1016
Mailing Address - Fax:
Practice Address - Street 1:1624 JOAN DR STE A
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94954-3657
Practice Address - Country:US
Practice Address - Phone:707-206-1016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF48019101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1696Medicare ID - Type Unspecified