Provider Demographics
NPI:1396847349
Name:RAST, RALPH E (MA, MFT)
Entity Type:Individual
Prefix:MR
First Name:RALPH
Middle Name:E
Last Name:RAST
Suffix:
Gender:M
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5819 OAK GARDEN CT
Mailing Address - Street 2:
Mailing Address - City:ORANGEVALE
Mailing Address - State:CA
Mailing Address - Zip Code:95662-4439
Mailing Address - Country:US
Mailing Address - Phone:916-761-6549
Mailing Address - Fax:
Practice Address - Street 1:3336 BRADSHAW RD STE 150
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95827-2600
Practice Address - Country:US
Practice Address - Phone:916-761-6549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 16563106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMFC 16563OtherMARRIAGE & FAMILY THERAPI