Provider Demographics
NPI:1992070098
Name:AGNOSCO THERAPY SOLUTIONS
Entity type:Organization
Organization Name:AGNOSCO THERAPY SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LMFT
Authorized Official - Prefix:
Authorized Official - First Name:VINH
Authorized Official - Middle Name:
Authorized Official - Last Name:MA
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:916-496-8810
Mailing Address - Street 1:9116 ELK GROVE BLVD
Mailing Address - Street 2:SUITE #125
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624-2074
Mailing Address - Country:US
Mailing Address - Phone:916-496-8810
Mailing Address - Fax:
Practice Address - Street 1:9116 ELK GROVE BLVD
Practice Address - Street 2:SUITE #125
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95624-2074
Practice Address - Country:US
Practice Address - Phone:916-496-8810
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-21
Last Update Date:2012-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50361106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty