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Organization
PETALUMA FAMILY THERAPY INC
Active
Organization
PETALUMA FAMILY THERAPY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARCUS MOORE (OWNER)
(707) 772-5085
Entity
Organization
Contact information
Practice address
1496 PROFESSIONAL DR STE 602, PETALUMA, CA 94954-6698
(707) 772-5085
Mailing address
1496 PROFESSIONAL DR STE 602, PETALUMA, CA 94954-6698
(707) 772-5085
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
NULL
101Y00000X
Counselor
—
—
101YP2500X
Professional Counselor
—
NULL
101YP2500X
Professional Counselor
—
—
1041C0700X
Clinical Social Worker
—
NULL
1041C0700X
Clinical Social Worker
—
—
106H00000X
Marriage & Family Therapist
Primary
—
NULL
106H00000X
Marriage & Family Therapist
Primary
—
—
Other
Enumeration date
09/26/2016
Last updated
07/31/2025
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