Provider Demographics
NPI:1649324310
Name:RATHAN, SEAN C (MFT)
Entity type:Individual
Prefix:MR
First Name:SEAN
Middle Name:C
Last Name:RATHAN
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:MR
Other - First Name:SEAN
Other - Middle Name:C
Other - Last Name:RATHAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MFT
Mailing Address - Street 1:10061 TALBERT AVE
Mailing Address - Street 2:#200
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-5159
Mailing Address - Country:US
Mailing Address - Phone:714-865-2157
Mailing Address - Fax:
Practice Address - Street 1:10061 TALBERT AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-5159
Practice Address - Country:US
Practice Address - Phone:714-865-2157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC35350106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA19780Medicaid