Provider Demographics
NPI:1205872025
Name:VLASAK, PATRICIA ANN (LMFT)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:ANN
Last Name:VLASAK
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MS
Other - First Name:TRISH
Other - Middle Name:
Other - Last Name:VLASAK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMFT
Mailing Address - Street 1:729 SUNRISE AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-4565
Mailing Address - Country:US
Mailing Address - Phone:916-772-1198
Mailing Address - Fax:916-772-1198
Practice Address - Street 1:729 SUNRISE AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-4565
Practice Address - Country:US
Practice Address - Phone:916-772-1198
Practice Address - Fax:916-772-1198
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-21
Last Update Date:2013-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC31115106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA680405078OtherEIN