Healthcare Provider Details

I. General information

NPI: 1942799432
Provider Name (Legal Business Name): JENNINE THAO-THU TRAN LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2018
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1792 TRIBUTE RD STE 350
SACRAMENTO CA
95815-4322
US

IV. Provider business mailing address

3400 DATA DR
RANCHO CORDOVA CA
95670-7956
US

V. Phone/Fax

Practice location:
  • Phone: 916-924-6400
  • Fax: 916-648-1614
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number121411
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: