Provider Demographics
NPI:1881715050
Name:CLOSE-NORMAN, PATRICIA ANN
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:ANN
Last Name:CLOSE-NORMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:PATRICIA
Other - Middle Name:ANN
Other - Last Name:NORMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 182
Mailing Address - Street 2:
Mailing Address - City:PENN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95946-0182
Mailing Address - Country:US
Mailing Address - Phone:530-673-0977
Mailing Address - Fax:530-432-8185
Practice Address - Street 1:1512 STARR DR STE B
Practice Address - Street 2:
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95993-2602
Practice Address - Country:US
Practice Address - Phone:530-673-0977
Practice Address - Fax:530-432-8185
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC35811106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist