Provider Demographics
NPI:1720395395
Name:POPPE, SIERRA MICHELE (MS, MFT)
Entity type:Individual
Prefix:
First Name:SIERRA
Middle Name:MICHELE
Last Name:POPPE
Suffix:
Gender:F
Credentials:MS, MFT
Other - Prefix:
Other - First Name:SIERRA
Other - Middle Name:MICHELE
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20 ASTORIA CIR
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94954-4616
Mailing Address - Country:US
Mailing Address - Phone:415-895-2212
Mailing Address - Fax:
Practice Address - Street 1:205 KELLER ST
Practice Address - Street 2:SUITE 205
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-2874
Practice Address - Country:US
Practice Address - Phone:415-895-2212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-02
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT53311106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist