Healthcare Provider Details

I. General information

NPI: 1679647382
Provider Name (Legal Business Name): SARA M OKUDA M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SARA BRANDT M.A.

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 09/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1475 HUNTINGTON AVE SUITE 201
SOUTH SAN FRANCISCO CA
94080-5990
US

IV. Provider business mailing address

PO BOX 1625
EL GRANADA CA
94018-1625
US

V. Phone/Fax

Practice location:
  • Phone: 415-412-7003
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE0004271
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number43956
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: