Provider Demographics
NPI:1770911836
Name:PETTENGILL, SARAH (MA, MFTI)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:PETTENGILL
Suffix:
Gender:F
Credentials:MA, MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27851 BRADLEY RD
Mailing Address - Street 2:SUITE 111
Mailing Address - City:MENIFEE
Mailing Address - State:CA
Mailing Address - Zip Code:92586-2286
Mailing Address - Country:US
Mailing Address - Phone:208-891-2134
Mailing Address - Fax:
Practice Address - Street 1:27851 BRADLEY RD
Practice Address - Street 2:SUITE 111
Practice Address - City:MENIFEE
Practice Address - State:CA
Practice Address - Zip Code:92586-2286
Practice Address - Country:US
Practice Address - Phone:208-891-2134
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-28
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMFTA.MG.60406418106H00000X
CAIMF82747101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist