Provider Demographics
NPI:1528064839
Name:ALLIENDE, EUGENE A (MFT)
Entity type:Individual
Prefix:
First Name:EUGENE
Middle Name:A
Last Name:ALLIENDE
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12140 NEW YORK RANCH ROAD
Mailing Address - Street 2:JACKSON RANCHERIA HEALTH COMPLEX
Mailing Address - City:JACKSON
Mailing Address - State:CA
Mailing Address - Zip Code:95642-9344
Mailing Address - Country:US
Mailing Address - Phone:209-257-2430
Mailing Address - Fax:209-257-2434
Practice Address - Street 1:12140 NEW YORK RANCH ROAD
Practice Address - Street 2:JACKSON RANCHERIA HEALTH COMPLEX
Practice Address - City:JACKSON
Practice Address - State:CA
Practice Address - Zip Code:95642-9344
Practice Address - Country:US
Practice Address - Phone:209-257-2430
Practice Address - Fax:209-257-2434
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 41429106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist