Provider Demographics
NPI:1396994687
Name:IVERSON, MARINTHA (MFT TRAINEE)
Entity type:Individual
Prefix:
First Name:MARINTHA
Middle Name:
Last Name:IVERSON
Suffix:
Gender:F
Credentials:MFT TRAINEE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2313 SHIRE LN
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-3059
Mailing Address - Country:US
Mailing Address - Phone:530-756-1370
Mailing Address - Fax:
Practice Address - Street 1:8233 E STOCKTON BLVD
Practice Address - Street 2:STE D
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95828-8203
Practice Address - Country:US
Practice Address - Phone:916-368-3080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-11
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist