Healthcare Provider Details

I. General information

NPI: 1033046958
Provider Name (Legal Business Name): INDABA FAMILY THERAPY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5701 LONETREE BLVD STE 113
ROCKLIN CA
95765-3792
US

IV. Provider business mailing address

1705 IROQUOIS CT
ROCKLIN CA
95765-5436
US

V. Phone/Fax

Practice location:
  • Phone: 916-751-6934
  • Fax:
Mailing address:
  • Phone: 916-751-6934
  • 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: KAREN OLIVIER
Title or Position: OWNER
Credential:
Phone: 916-751-6934