Provider Demographics
NPI:1043850837
Name:KONAN, ESSEMONE HERVEE MELIANE
Entity type:Individual
Prefix:
First Name:ESSEMONE
Middle Name:HERVEE MELIANE
Last Name:KONAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7969 PEBBLE BEACH DR APT 132
Mailing Address - Street 2:
Mailing Address - City:CITRUS HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:95610-7764
Mailing Address - Country:US
Mailing Address - Phone:916-793-0436
Mailing Address - Fax:
Practice Address - Street 1:2151 PROFESSIONAL DR STE 100
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3761
Practice Address - Country:US
Practice Address - Phone:916-771-0520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-09
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician