Healthcare Provider Details

I. General information

NPI: 1689392193
Provider Name (Legal Business Name): SARA ELIZABETH HACK LMFT, LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2022
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2750 G ST STE E1
MERCED CA
95340-2953
US

IV. Provider business mailing address

PO BOX 2921
MERCED CA
95344-0921
US

V. Phone/Fax

Practice location:
  • Phone: 209-336-8720
  • Fax:
Mailing address:
  • Phone: 209-233-1998
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number162988
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: