Active NPI
Sharon Izen-Tengbergen, M.F.T.
- Mental Health Counselor
- Vacaville, CA
National Provider Identifier
1386786572
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- MFC 31994
- Practice address
- 419 Mason St Ste 201
Vacaville, CA 95688-4535 - Phone
- (707) 491-4494
- Fax
- (707) 766-9953
- NPI assigned
- Feb 13, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | MFC 31994 | CA | Primary |
Addresses
Primary practice location
419 Mason St Ste 201
Vacaville, CA 95688-4535
Mailing address
925 Lakeville St # 254
Petaluma, CA 94952-3329
Phone (707) 491-4494
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250501002942 | CA | Practitioner - Marriage and Family Therapist | 0547786543 | Practice locations: Petaluma, CA |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MFC 31994 | CA | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171324800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1386786572",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "925 LAKEVILLE ST # 254",
"city": "PETALUMA",
"state": "CA",
"postal_code": "949523329",
"telephone_number": "707-491-4494",
"fax_number": "707-766-9953"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "419 MASON ST STE 201",
"city": "VACAVILLE",
"state": "CA",
"postal_code": "956884535",
"telephone_number": "707-491-4494",
"fax_number": "707-766-9953"
}
],
"practiceLocations": [],
"basic": {
"last_name": "IZEN-TENGBERGEN",
"first_name": "SHARON",
"name_prefix": "Ms.",
"credential": "M.F.T.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-02-13",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "CA",
"license": "MFC 31994",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Vacaville, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.