Nathan Shawn Peralta Thephavongsa

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

151868 Issued in CA

Practice address

5445 Laurel Hills Dr
Sacramento, CA 95841-3105

Phone

(916) 609-5100

NPI assigned

Jul 1, 2022

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Corrections and Rehabilitation-Headquarters

  • Pharmacy
  • Represa, CA
  • NPI 1154953529
  NPD
• Heartland Child & Family Services

  • Adolescent and Children Mental Health Clinic/Center
  • Sacramento, CA
  • NPI 1295814739
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1656633600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1772668800000",
    "number": "1912630450",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3341 JAMI CT",
            "city": "ROSEVILLE",
            "state": "CA",
            "postal_code": "957479149",
            "telephone_number": "408-438-7827"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5445 LAUREL HILLS DR",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958413105",
            "telephone_number": "916-609-5100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THEPHAVONGSA",
        "first_name": "NATHAN SHAWN",
        "middle_name": "PERALTA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-07-01",
        "last_updated": "2026-03-05",
        "certification_date": "2026-03-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "151868",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ann Theobald, CP
• Nicholas J Theobald, CRNA
• Theodore a. Goodman MD Inc.
• Christina Theodorou, M.D.
• Coby Theodosis, RRT
• Shynice Therman
• Marcus Theus, MD
• Simran Kaur Thiara, M.D.
• Amy Thibault, ACSW
• Garrett Gray Thiel, M.D.

• Marriage & Family Therapist in Sacramento, CA
• Providers in Sacramento, CA by specialty
• Marriage & Family Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.