MEDICARE: SONAL DHILLON M.A., LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	85497	CA

General Provider Information

NPI Number	:	1487003596
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SONAL DHILLON M.A., LMFT

Provider Business Mailing Address
First Line	:	1380 LEAD HILL BLVD STE 160
Second Line	:
City	:	ROSEVILLE
State	:	CA
Zip	:	95661-2998
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1380 LEAD HILL BLVD STE 160
Second Line	:
City	:	ROSEVILLE
State	:	CA
Zip	:	95661-2998
Country	:	US
Telephone Number	:	916-893-0265
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2016
Last Update Date	:	06/09/2016

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