Healthcare Provider Details

I. General information

NPI: 1629081252
Provider Name (Legal Business Name): ALYSON M. GIARDINI LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 12/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9214 MARYSVILLE RD
OREGON HOUSE CA
95962-9705
US

IV. Provider business mailing address

PO BOX 472
BANGOR CA
95914-0472
US

V. Phone/Fax

Practice location:
  • Phone: 510-594-4066
  • Fax: 510-594-4066
Mailing address:
  • Phone: 510-594-4066
  • Fax: 510-594-4066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC39327
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: