Healthcare Provider Details

I. General information

NPI: 1184928004
Provider Name (Legal Business Name): SARA LYNN PLYLEY MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2011
Last Update Date: 10/06/2022
Certification Date: 10/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1035 BONITA AVE
LA VERNE CA
91750-5109
US

IV. Provider business mailing address

233 BASELINE RD
LA VERNE CA
91750-2353
US

V. Phone/Fax

Practice location:
  • Phone: 909-821-9023
  • Fax:
Mailing address:
  • Phone: 909-593-2581
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMF63853
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number115172
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: