Provider Demographics
NPI:1255638482
Name:SCHIBSTED, PENELOPE A (MFT)
Entity type:Individual
Prefix:
First Name:PENELOPE
Middle Name:A
Last Name:SCHIBSTED
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:PENELOPE
Other - Middle Name:ANNE
Other - Last Name:SCHIBSTED
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 96
Mailing Address - Street 2:
Mailing Address - City:SUNSET BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90742-0096
Mailing Address - Country:US
Mailing Address - Phone:714-928-5049
Mailing Address - Fax:714-835-8848
Practice Address - Street 1:1401 N TUSTIN AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-8644
Practice Address - Country:US
Practice Address - Phone:714-835-8819
Practice Address - Fax:714-835-8848
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-24
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40756106H00000X
CA294961163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No163W00000XNursing Service ProvidersRegistered Nurse