Provider Demographics
NPI:1134596505
Name:WIRTZ MILLER, JOANNA LESLIE
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:LESLIE
Last Name:WIRTZ MILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JOANNE
Other - Middle Name:LESLIE
Other - Last Name:WIRTZ MILLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MFT
Mailing Address - Street 1:330 FLUME ST
Mailing Address - Street 2:#100
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928-5400
Mailing Address - Country:US
Mailing Address - Phone:530-345-8337
Mailing Address - Fax:
Practice Address - Street 1:330 FLUME ST
Practice Address - Street 2:#100
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95928-5400
Practice Address - Country:US
Practice Address - Phone:530-345-8337
Practice Address - Fax:530-809-2669
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-01
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC46237106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist