Basic Information
Provider Information
NPI: 1437409422
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CALVIN
FirstName: MORGAN
MiddleName: BRITTANEY
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 6833 STOCKTON BLVD
Address2: SUITE 485
City: SACRAMENTO
State: CA
PostalCode: 958232372
CountryCode: US
TelephoneNumber: 9163940800
FaxNumber: 9164297824
Practice Location
Address1: 6833 STOCKTON BLVD
Address2: SUITE 485
City: SACRAMENTO
State: CA
PostalCode: 958232372
CountryCode: US
TelephoneNumber: 9163940800
FaxNumber: 9164297824
Other Information
ProviderEnumerationDate: 09/17/2012
LastUpdateDate: 02/21/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
106H00000X  N Behavioral Health & Social Service ProvidersMarriage & Family Therapist 
101Y00000X CAN Behavioral Health & Social Service ProvidersCounselor 
106H00000X79163CAY Behavioral Health & Social Service ProvidersMarriage & Family Therapist 

No ID Information.


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