Healthcare Provider Details

I. General information

NPI: 1205583283
Provider Name (Legal Business Name): SARAH REZAK LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2022
Last Update Date: 03/09/2022
Certification Date: 03/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1460 7TH ST STE 300
SANTA MONICA CA
90401-2632
US

IV. Provider business mailing address

2029 OAK ST APT B
SANTA MONICA CA
90405-4969
US

V. Phone/Fax

Practice location:
  • Phone: 323-285-0107
  • Fax:
Mailing address:
  • Phone: 310-804-3240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number131603
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: