MEDICARE: SASHA HAWKES MARRIAGE AND FAMILY THERAPY

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

General Provider Information

NPI Number	:	1528762846
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SASHA HAWKES MARRIAGE AND FAMILY THERAPY

Provider Business Mailing Address
First Line	:	5020 SAN VICENTE BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90019-2954
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5020 SAN VICENTE BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90019-2954
Country	:	US
Telephone Number	:	213-910-4520
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	SASHA HAWKES
Credential	:
Telephone Number	:	213-910-4520

Provider Enumeration Date	:	03/29/2023
Last Update Date	:	03/29/2023

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