Provider Demographics
NPI:1386094316
Name:REED, MOLLY ROSE (LMFT)
Entity type:Individual
Prefix:MS
First Name:MOLLY
Middle Name:ROSE
Last Name:REED
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 FARMERS LN
Mailing Address - Street 2:SUITE 16
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-6710
Mailing Address - Country:US
Mailing Address - Phone:707-971-0216
Mailing Address - Fax:
Practice Address - Street 1:2635 CLEVELAND AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-2989
Practice Address - Country:US
Practice Address - Phone:707-971-0216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-21
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT90056106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist