Provider Demographics
NPI:1871582965
Name:BINGHAM, JOHN PRATT (MA)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:PRATT
Last Name:BINGHAM
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4940 ARTESIA RD
Mailing Address - Street 2:
Mailing Address - City:SHINGLE SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:95682-9515
Mailing Address - Country:US
Mailing Address - Phone:530-676-9050
Mailing Address - Fax:
Practice Address - Street 1:9851 HORN RD
Practice Address - Street 2:SUITE 180
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95827-1993
Practice Address - Country:US
Practice Address - Phone:916-366-0164
Practice Address - Fax:916-366-0149
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT 14489106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist