Provider Demographics
NPI:1366575409
Name:NOLAN, ROBERTA (PHD LMFT)
Entity type:Individual
Prefix:MS
First Name:ROBERTA
Middle Name:
Last Name:NOLAN
Suffix:
Gender:F
Credentials:PHD LMFT
Other - Prefix:DR
Other - First Name:ROBIN
Other - Middle Name:
Other - Last Name:NOLAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD LMFT
Mailing Address - Street 1:615 HARRIS ST
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95503-4447
Mailing Address - Country:US
Mailing Address - Phone:707-599-7366
Mailing Address - Fax:
Practice Address - Street 1:615 HARRIS ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95503-4447
Practice Address - Country:US
Practice Address - Phone:530-360-6259
Practice Address - Fax:707-407-0566
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT51661106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1366575409OtherVICTIM WITNESS
CA1366575409OtherANTHEN