Healthcare Provider Details

I. General information

NPI: 1750197679
Provider Name (Legal Business Name): SAREENITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2024
Last Update Date: 12/05/2024
Certification Date: 12/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 N 3RD ST # 319
BURBANK CA
91502-1107
US

IV. Provider business mailing address

11400 TERRA VISTA WAY
SYLMAR CA
91342-6526
US

V. Phone/Fax

Practice location:
  • Phone: 818-406-9957
  • Fax:
Mailing address:
  • Phone: 818-406-9957
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SAREEN KHODABAKHSH
Title or Position: LMFT
Credential:
Phone: 818-406-9957