TLC CHILD AND FAMILY SERVICES (NPI# 1639226814) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1639226814 |
| Entity Type | Organization |
| Organization Name | TLC CHILD AND FAMILY SERVICES |
| Other Organization Name | TLC CHILD AND FAMILY SERVICES |
| Practice Address |
1800 Gravenstein Hwy N Bldg A - E Sebastopol CA 95472-2607 |
| Mailing Address |
1800 Gravenstein Hwy N Suite A Sebastopol CA 95472-2607 |
| Practice Telephone | 7078237300 |
| Practice Fax Number | 7078233410 |
| Mailing Telephone | 7078237300 |
| Mailing Fax Number | 7078233410 |
| Enumeration Date | 2007-01-03 |
| Last Update Date | 2020-02-19 |
| Authorized Official Name | SUSAN FETTE (CEO) |
| Authorized Official Telephone | 7076349932 |
| Authorized Official Credential | MFT |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM0855X |
Clinic/Center Specialization: Adolescent and Children Mental Health |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| TLC Child and Family Services | Former Legal Business Name - Organization |
| Street Address |
1800 GRAVENSTEIN HWY N BLDG A - E |
| City | SEBASTOPOL |
| State | CA |
| Zip Code | 95472-2607 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053926766 | Mary Peterson | Counselor | 1800 Gravenstein Hwy N, Sebastopol, CA 95472-2607 | 2020-09-10 |
| 1588206437 | Melissa Salini | Social Worker | 1800 Gravenstein Hwy N, Sebastopol, CA 95472-2607 | 2019-10-11 |
| 1417446543 | Anna Vittoria Frattolillo | Marriage & Family Therapist | 1800 Gravenstein Hwy N, Sebastopol, CA 95472-2607 | 2018-05-03 |
| 1700374147 | Melissa Coello | Counselor | 1800 Gravenstein Hwy N, Sebastopol, CA 95472-2607 | 2018-05-01 |
| 1619473295 | Elizabeth Barone | Counselor | 1800 Gravenstein Hwy N, Sebastopol, CA 95472-2607 | 2018-04-03 |
| 1720536329 | Lawrence Segrue | Marriage & Family Therapist | 1800 Gravenstein Hwy N, Sebastopol, CA 95472-2607 | 2016-09-13 |
| 1053867739 | Heather Tidrick | Counselor | 1800 Gravenstein Hwy N, Sebastopol, CA 95472-2607 | 2016-08-31 |
| 1285095638 | Nima Saalabi | Counselor | 1800 Gravenstein Hwy N, Sebastopol, CA 95472-2607 | 2016-03-14 |
| 1770985558 | Aimee Fouche | Marriage & Family Therapist | 1800 Gravenstein Hwy N, Sebastopol, CA 95472-2607 | 2014-09-23 |
| 1598165003 | Anna Eraquin Nelson | Counselor | 1800 Gravenstein Hwy N, Sebastopol, CA 95472 | 2014-09-03 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558916791 | Mellisa Nicole Elrod | Occupational Therapist | 1935 Gravenstein Hwy, Sebastopol, CA 95472 | 2019-08-05 |
| 1457820987 | Isabel Brooke Martinez | Acupuncturist | 961 Gravenstein Hwy South, # 100, Sebastopol, CA 95472 | 2018-11-14 |
| 1275025470 | Shahbano Syeda | Specialist/Technologist | 846/848 Gravenstein Hwy South, Sebastopol, CA 95472 | 2018-06-04 |
| 1467990812 | Mathew Metzgar | Marriage & Family Therapist | 1800 N. Gravenstein Hwy, Sebastopol, CA 95472 | 2017-02-06 |
| 1760939318 | Andrea Kirk | Psychologist | 876 Gravenstein Hwy S., Suite 6, Sebastopol, CA 95472 | 2016-09-01 |
| 1548629371 | Stacy Simons | Massage Therapist | 103 Morris St Ste V, Sebastopol, CA 95472 | 2016-02-22 |
| 1619341880 | Carol Schmid | Counselor | 1800 N, Gravenstein Hwy, Sebastopol, CA 95472 | 2015-11-25 |
| 1801273727 | Aaron Martinez | Specialist/Technologist | 7441 Witter Road, Sebastopol, CA 95472 | 2015-04-29 |
| 1699167049 | Nia Kaye | Marriage & Family Therapist | 130 Petaluma Ave Ste 2c, Sebastopol, CA 95472 | 2015-02-23 |
| 1497091383 | Caitlin Marie Kirkman | Midwife | 5611 Hessel Ave, Sebastopol, CA 95472 | 2012-12-20 |
| Find all providers in zip 95472 | ||||
| Taxonomy Code | 261QM0855X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Adolescent and Children Mental Health |
| An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in children and adolescents. Services may be provided to parents and family members of the patient in the form of conjoint, group, or individual therapy, and education and/or training. |
| Notes: [7/1/2003: new] |
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| 1083230262 | Socal Adolescent Wellness, Inc. | Clinic/Center | 23072 Lake Center Dr Ste 214, Lake Forest, CA 92630-2899 | 2020-06-23 |
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| Find all providers with the same taxonomy | ||||
| City | SEBASTOPOL |
| Zip Code | 95472 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.