Organization
MISSING ELEMENTS
Active
Organization
MISSING ELEMENTS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUZE CRIBBS LMFT (CLINICAL DIRECTOR)
(707) 560-1051
Entity
Organization
Contact information
Practice address
1717 YULUPA AVE STE 5, SANTA ROSA, CA 95405-6201
(707) 560-1051
(866) 803-4979
Mailing address
PO BOX 882, SANTA ROSA, CA 95402-0882
(707) 560-1051
(866) 803-4979
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
251S00000X
Community/Behavioral Health Agency
Primary
IMF55305
CA
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
Other
Enumeration date
11/08/2012
Last updated
04/01/2024
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