Provider Demographics
NPI:1962878520
Name:HIBBERD-MILLER, PATREA (MFT)
Entity type:Individual
Prefix:
First Name:PATREA
Middle Name:
Last Name:HIBBERD-MILLER
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:PATREA
Other - Middle Name:ANN
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MFT
Mailing Address - Street 1:15960 DRAKE RD
Mailing Address - Street 2:
Mailing Address - City:GUERNEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95446-9734
Mailing Address - Country:US
Mailing Address - Phone:707-235-7760
Mailing Address - Fax:
Practice Address - Street 1:100 E ST STE 305
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-4607
Practice Address - Country:US
Practice Address - Phone:707-235-7760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-18
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT53814106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist