Provider Demographics
NPI:1730440223
Name:REDWOOD PSYCHALLIANCE
Entity type:Organization
Organization Name:REDWOOD PSYCHALLIANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LORETTE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:LABATAILLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:707-568-1101
Mailing Address - Street 1:509 7TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95401-5297
Mailing Address - Country:US
Mailing Address - Phone:707-568-1101
Mailing Address - Fax:707-568-1103
Practice Address - Street 1:509 7TH ST STE 100
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-5297
Practice Address - Country:US
Practice Address - Phone:707-568-1101
Practice Address - Fax:707-568-1103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-31
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC25326106H00000X
CAA338632084P0804X
CAG240402084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty