Provider Demographics
NPI:1881203602
Name:BEHRENS, MOLLY JEAN (MFT)
Entity Type:Individual
Prefix:MS
First Name:MOLLY
Middle Name:JEAN
Last Name:BEHRENS
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 BUCK AVE
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95688-3618
Mailing Address - Country:US
Mailing Address - Phone:707-372-0348
Mailing Address - Fax:
Practice Address - Street 1:419 ELIZABETH ST STE 1
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95688-4602
Practice Address - Country:US
Practice Address - Phone:707-372-0345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-28
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT129323106H00000X, 106H00000X
106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist