Provider Demographics
NPI:1497866743
Name:SIPANYA, VAN (MFT)
Entity Type:Individual
Prefix:
First Name:VAN
Middle Name:
Last Name:SIPANYA
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3230 ARENA BLVD STE 245-106
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95834-1099
Mailing Address - Country:US
Mailing Address - Phone:916-214-0276
Mailing Address - Fax:916-214-0276
Practice Address - Street 1:8001 BRUCEVILLE RD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-2329
Practice Address - Country:US
Practice Address - Phone:916-288-0300
Practice Address - Fax:916-288-0300
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 45175106H00000X
CAMFC 48724106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist