Healthcare Provider Details

I. General information

NPI: 1588441141
Provider Name (Legal Business Name): SARAH OLNEY COUNSELING INTERN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2023
Last Update Date: 09/08/2023
Certification Date: 09/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21448 N 75TH AVE
GLENDALE AZ
85308-5978
US

IV. Provider business mailing address

7634 W MICHIGAN AVE
GLENDALE AZ
85308-8245
US

V. Phone/Fax

Practice location:
  • Phone: 714-348-4856
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: