Provider Demographics
NPI:1205966447
Name:VANDENBOS, MONIQUE A (MA, LMFT)
Entity type:Individual
Prefix:MS
First Name:MONIQUE
Middle Name:A
Last Name:VANDENBOS
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8331 SIERRA COLLEGE BLVD
Mailing Address - Street 2:SUITE 222
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-9486
Mailing Address - Country:US
Mailing Address - Phone:916-749-8000
Mailing Address - Fax:
Practice Address - Street 1:8331 SIERRA COLLEGE BLVD
Practice Address - Street 2:SUITE 222
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-9486
Practice Address - Country:US
Practice Address - Phone:916-749-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47589106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist