Healthcare Provider Details

I. General information

NPI: 1265379937
Provider Name (Legal Business Name): TONYA ALLEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TONI ALLEN

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9659 SWAN LAKE DR
GRANITE BAY CA
95746-6608
US

IV. Provider business mailing address

9659 SWAN LAKE DR
GRANITE BAY CA
95746-6608
US

V. Phone/Fax

Practice location:
  • Phone: 916-888-8664
  • Fax: 916-888-8664
Mailing address:
  • Phone: 916-888-8664
  • Fax: 916-888-8664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: