MEDICARE: SEJLA SERIFOVIC

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	101YM0800X	Mental Health Counselor	LH60567967	WA
2	101YP2500X	Professional Counselor	9598	CA

General Provider Information

NPI Number	:	1194219543
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SEJLA SERIFOVIC

Provider Business Mailing Address
First Line	:	340 2ND ST STE 8
Second Line	:
City	:	LOS ALTOS
State	:	CA
Zip	:	94022-3651
Country	:	US
Telephone Number	:	650-374-7255
Fax Number	:

Provider Business Practice Location Address
First Line	:	340 2ND ST STE 8
Second Line	:
City	:	LOS ALTOS
State	:	CA
Zip	:	94022-3651
Country	:	US
Telephone Number	:	650-374-7255
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/19/2018
Last Update Date	:	03/20/2022

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Directions to “ SEJLA SERIFOVIC ” Practice Location

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