MEDICARE: SARAH LONGSON MFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	01337	NV

General Provider Information

NPI Number	:	1114399110
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SARAH LONGSON MFT

Provider Business Mailing Address
First Line	:	3501 W CHARLESTON BLVD
Second Line	:	#100
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-1839
Country	:	US
Telephone Number	:	702-449-9001
Fax Number	:	844-872-4570

Provider Business Practice Location Address
First Line	:	3501 W CHARLESTON BLVD
Second Line	:	#100
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-1839
Country	:	US
Telephone Number	:	702-449-9001
Fax Number	:	844-872-4570

Authorized Official
Title or Position	:	OWNER
Name	:	SARAH LONGSON
Credential	:	LMFT
Telephone Number	:	702-449-9001

Provider Enumeration Date	:	10/29/2015
Last Update Date	:	10/29/2015

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