# MAGGIE SELF, LMFT

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1306484605
- **Authorized official:** MRS. MAGGIE ROSE SELF MS, LMFT (LMFT)
- **Authorized official phone:** (707) 583-9518

## Contact information

- **Practice address:** 7765 HEALDSBURG AVE, SEBASTOPOL, CA 95472-3309
- **Practice address phone:** (707) 583-9518
- **Practice address fax:** (877) 795-8030
- **Mailing address:** PO BOX 173, SEBASTOPOL, CA 95473-0173
- **Mailing address phone:** (707) 583-9518

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 106H00000X | Marriage & Family Therapist | — | NULL | Yes |
| 106H00000X | Marriage & Family Therapist | — | — | Yes |

## Other

- **Enumeration date:** 12/17/2019
- **Last updated:** 12/17/2019