Provider Demographics
NPI:1679821664
Name:ROCHE, KORLANY CHHUN (PSYD, MFT)
Entity Type:Individual
Prefix:DR
First Name:KORLANY
Middle Name:CHHUN
Last Name:ROCHE
Suffix:
Gender:F
Credentials:PSYD, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12779 THORNBERG WAY
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95742-7800
Mailing Address - Country:US
Mailing Address - Phone:916-997-2303
Mailing Address - Fax:
Practice Address - Street 1:12779 THORNBERG WAY
Practice Address - Street 2:
Practice Address - City:RANCHO CORDOVA
Practice Address - State:CA
Practice Address - Zip Code:95742-7800
Practice Address - Country:US
Practice Address - Phone:916-997-2303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-22
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA#87271106H00000X
CA87271106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist