Provider Demographics
NPI:1740628940
Name:WIEGEL, DEBRA ANN (MFT)
Entity type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:ANN
Last Name:WIEGEL
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 1:827 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:WOODLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95695-3537
Mailing Address - Country:US
Mailing Address - Phone:530-668-9231
Mailing Address - Fax:530-668-6361
Practice Address - Street 1:827 NORTH ST
Practice Address - Street 2:
Practice Address - City:WOODLAND
Practice Address - State:CA
Practice Address - Zip Code:95695-3537
Practice Address - Country:US
Practice Address - Phone:530-668-9231
Practice Address - Fax:530-668-6361
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-10
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC27597106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist