| Bitterroot Family Therapy Inc. | |
|
347 Cypress St Ste A Fort Bragg CA 95437-5458 | |
| (707) 962-3161 | |
| (707) 937-1876 |
| Full Name | Bitterroot Family Therapy Inc. |
|---|---|
| Speciality | Counselor |
| Location | 347 Cypress St Ste A, Fort Bragg, California |
| Authorized Official Name and Position | Lisa Larimer Burtis (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 7079623161 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bitterroot Family Therapy Inc. Po Box 653 Mendocino CA 95460-0653 Ph: (707) 962-3161 | Bitterroot Family Therapy Inc. 347 Cypress St Ste A Fort Bragg CA 95437-5458 Ph: (707) 962-3161 |
| NPI Number | 1003401910 |
|---|---|
| Provider Enumeration Date | 03/02/2021 |
| Last Update Date | 06/20/2022 |
| Certification Date | 06/20/2022 |
| Medicare PECOS PAC ID | 2163875287 |
|---|---|
| Medicare Enrollment ID | O20240125000609 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003401910 | NPI | - | NPPES |
| 1952445454 | Medicaid | CA |
| Provider Name | Lisa Larimer Burtis |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1952445454 PECOS PAC ID: 4981057007 Enrollment ID: I20240209001084 |
| Provider Name | Peter K Burtis |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1609083609 PECOS PAC ID: 5890148910 Enrollment ID: I20240219000315 |
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