Healthcare Provider Details

I. General information

NPI: 1609306331
Provider Name (Legal Business Name): SUNUM KHATIBA JAMALL LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2017
Last Update Date: 06/28/2024
Certification Date: 06/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HOWE AVE STE 170N
SACRAMENTO CA
95825-8241
US

IV. Provider business mailing address

100 HOWE AVE STE 170N
SACRAMENTO CA
95825-8241
US

V. Phone/Fax

Practice location:
  • Phone: 925-282-1778
  • Fax: 415-296-5299
Mailing address:
  • Phone: 925-282-1778
  • Fax: 415-296-5299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number146780
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: