Provider Demographics
NPI:1124839626
Name:MACHGAN, JEFFREY (LMFT)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:MACHGAN
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:919 CAMPFIRE CIR
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95765-5345
Mailing Address - Country:US
Mailing Address - Phone:916-903-3247
Mailing Address - Fax:
Practice Address - Street 1:8150 INDUSTRIAL AVE BLDG A
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678-5903
Practice Address - Country:US
Practice Address - Phone:916-562-1377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-15
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA129877106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist