Healthcare Provider Details

I. General information

NPI: 1184357790
Provider Name (Legal Business Name): SYDNEY EGAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2022
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2180 JOHNSON AVE
SAN LUIS OBISPO CA
93401-4558
US

IV. Provider business mailing address

1519 BEACH ST
SAN LUIS OBISPO CA
93401-4317
US

V. Phone/Fax

Practice location:
  • Phone: 310-697-9926
  • Fax:
Mailing address:
  • Phone: 310-697-9926
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number157665
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number20217
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: