Provider Demographics
NPI:1841735669
Name:VACAVILLE MUSIC THERAPY
Entity Type:Organization
Organization Name:VACAVILLE MUSIC THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRIANNA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MCCULLOCH
Authorized Official - Suffix:
Authorized Official - Credentials:MM, MT-BC
Authorized Official - Phone:707-718-1103
Mailing Address - Street 1:255 ALDER CREST WAY
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95688-9266
Mailing Address - Country:US
Mailing Address - Phone:707-718-1103
Mailing Address - Fax:
Practice Address - Street 1:183 BUTCHER RD
Practice Address - Street 2:SUITE B
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95687-5690
Practice Address - Country:US
Practice Address - Phone:707-718-1103
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-03
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic TherapistGroup - Single Specialty