Provider Demographics
NPI:1871042366
Name:THUET, SADIE
Entity Type:Individual
Prefix:
First Name:SADIE
Middle Name:
Last Name:THUET
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1070 GRAVENSTEIN HWY S
Mailing Address - Street 2:SUITE 120
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472-4529
Mailing Address - Country:US
Mailing Address - Phone:707-243-3168
Mailing Address - Fax:
Practice Address - Street 1:1070 GRAVENSTEIN HWY S
Practice Address - Street 2:SUITE 120
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472-4529
Practice Address - Country:US
Practice Address - Phone:707-596-2365
Practice Address - Fax:707-708-2188
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-26
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA92492106H00000X
CA128139106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist