Provider Demographics
NPI:1265275598
Name:MONIQUE VANDENBOS MARRIAGE FAMILY THERAPIST INC.
Entity type:Organization
Organization Name:MONIQUE VANDENBOS MARRIAGE FAMILY THERAPIST INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MONIQUE
Authorized Official - Middle Name:A
Authorized Official - Last Name:VANDENBOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-749-8000
Mailing Address - Street 1:5960 S LAND PARK DR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95822-3313
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2649 CASTRO WAY
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95818
Practice Address - Country:US
Practice Address - Phone:916-749-8000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-14
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty