Provider Demographics
NPI:1780142026
Name:MUONGPRUAN, MANORAH (MS)
Entity type:Individual
Prefix:MS
First Name:MANORAH
Middle Name:
Last Name:MUONGPRUAN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:TRUE NORTH
Other - Middle Name:
Other - Last Name:PSYCHOTHERAPY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5340 GARFIELD AVE.
Mailing Address - Street 2:#3
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95841
Mailing Address - Country:US
Mailing Address - Phone:909-844-4610
Mailing Address - Fax:
Practice Address - Street 1:5340 GARFIELD AVE APT 3
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95841-3137
Practice Address - Country:US
Practice Address - Phone:909-844-4610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-05
Last Update Date:2025-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA158248106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist