Provider Demographics
NPI:1649383696
Name:PHARO, ALLYN (MFT INTERN W MA)
Entity Type:Individual
Prefix:MS
First Name:ALLYN
Middle Name:
Last Name:PHARO
Suffix:
Gender:F
Credentials:MFT INTERN W MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1440 LORIMER WAY
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:98747
Mailing Address - Country:US
Mailing Address - Phone:916-773-2465
Mailing Address - Fax:916-344-0196
Practice Address - Street 1:4216 ROSEVILLE RD
Practice Address - Street 2:
Practice Address - City:NORTH HIGHLANDS
Practice Address - State:CA
Practice Address - Zip Code:95660
Practice Address - Country:US
Practice Address - Phone:916-344-0199
Practice Address - Fax:916-344-0196
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALPHA7179106H00000X
CAIMF40970106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist