ALICE D PETTY-HANNUM MFT
NPI 1790989119
Marriage & Family Therapist in Santa Rosa, CA

Q: What is Alice Petty-hannum's NPI number?

The NPI number for Alice Petty-hannum is 1790989119. It was assigned to this individual provider in the NPPES registry on June 11, 2007. The provider is also known as Alice D Petty Mft.

Q: What is Alice Petty-hannum's specialty?

The primary specialty registered for this NPI is Marriage & Family Therapist with taxonomy code 106H00000X.

Q: Is Alice Petty-hannum enrolled in Medicare?

No. Alice Petty-hannum has opted out of Medicare through January 1, 2028. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out.

Active since June 11, 2007Opted out of Medicare · through Jan 1, 2028

406 CHINN ST, SANTA ROSA, CA 95404(707) 495-5350(707) 570-2680 Get Directions Write a Review

NPPES record last updated: August 25, 2011. Verified against the NPPES registry weekly; last sync: August 02, 2026.

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About Alice D Petty-hannum Mft NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ALICE D PETTY-HANNUM MFT (NPI 1790989119) is an individual marriage & family therapist in Santa Rosa, California, licensed in California (43967) and active in the NPI registry since June 2007. She has opted out of Medicare through January 1, 2028.

NPPES Registry Identity

NPI1790989119

Entity TypeIndividualFemale

Primary Taxonomy106H00000X

Provider Legal NameALICE D PETTY-HANNUMCredential: MFT

Location Address406 CHINN STSanta Rosa, CA 95404-4339

Mailing Address406 Chinn StSanta Rosa, CA 95404-4339 · (707) 495-5350 · Fax (707) 570-2680

Phone(707) 495-5350

Fax(707) 570-2680

Sole ProprietorYes

Enumeration DateJune 11, 2007

Last NPPES UpdateAugust 25, 2011

✔ NPI 1790989119 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyMarriage & Family TherapistBehavioral Health & Social Service Providers

Taxonomy Code106H00000X

License✔ Licensed in CA · 43967

Definition

A marriage and family therapist is a person with a master's degree in marriage and family therapy, or a master's or doctoral degree in a related mental health field with substantially equivalent coursework in marriage and family therapy, who receives supervised clinical experience, or a person who meets the state requirements to practice as a marriage and family therapist. A marriage and family therapist treats mental and emotional disorders within the context of marriage and family systems. A marriage and family therapist provides mental health and counseling services to individuals, couples, families, and groups.

406 CHINN ST, Santa Rosa, CA 95404

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Other Names 1

Former Name (1)Alice D Petty Mft

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Alice D Petty-hannum Mft has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from January 1, 2024 through January 1, 2028.

Opt-Out Effective DateJanuary 1, 2024

Opt-Out In Effect ThroughJanuary 1, 2028Opt-out affidavits renew automatically every two years unless cancelled

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