Healthcare Provider Details

I. General information

NPI: 1184232092
Provider Name (Legal Business Name): SARAH HULTQUIST LMFT
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2020
Last Update Date: 08/21/2024
Certification Date: 08/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26791 ALISO CREEK RD # 1080
ALISO VIEJO CA
92656-2887
US

IV. Provider business mailing address

26791 ALISO CREEK RD # 1080
ALISO VIEJO CA
92656-2887
US

V. Phone/Fax

Practice location:
  • Phone: 949-232-3359
  • Fax:
Mailing address:
  • Phone: 949-232-3359
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number135697
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: