Healthcare Provider Details

I. General information

NPI: 1437083771
Provider Name (Legal Business Name): IMAGINE ARTS AND FAMILY THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11238 VISTA AVE
GRASS VALLEY CA
95945-4849
US

IV. Provider business mailing address

PO BOX 431
NEVADA CITY CA
95959-0431
US

V. Phone/Fax

Practice location:
  • Phone: 530-277-5508
  • Fax:
Mailing address:
  • Phone: 530-277-5508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: SHELLEE ANN SEPKO
Title or Position: PRESIDENT
Credential: LMFT
Phone: 530-277-5508