Healthcare Provider Details

I. General information

NPI: 1013499219
Provider Name (Legal Business Name): ALLEN SAEPHAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2018
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 PARK AVE
MODESTO CA
95354-0556
US

IV. Provider business mailing address

920 16TH ST STE B
MODESTO CA
95354-1119
US

V. Phone/Fax

Practice location:
  • Phone: 209-558-4595
  • Fax:
Mailing address:
  • Phone: 209-558-4595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number163679
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: