Provider Demographics
NPI:1780392738
Name:SANDOVAL, ALYSON TAYLOR (LMFT)
Entity type:Individual
Prefix:
First Name:ALYSON
Middle Name:TAYLOR
Last Name:SANDOVAL
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4160 PINE ST
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95677-2404
Mailing Address - Country:US
Mailing Address - Phone:916-770-5083
Mailing Address - Fax:
Practice Address - Street 1:3300 DOUGLAS BLVD STE 240
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-4287
Practice Address - Country:US
Practice Address - Phone:916-770-5083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-08
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT135085101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health