=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033841614
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SARAH ROSENBLOOM MFT-INTERN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/30/2022
-----------------------------------------------------
Last Update Date | 06/30/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1325 AIRMOTIVE WAY STE 240
-----------------------------------------------------
City | RENO
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89502-3284
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 775-737-9001
-----------------------------------------------------
Fax | 775-870-1628
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1325 AIRMOTIVE WAY STE 240
-----------------------------------------------------
City | RENO
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89502-3284
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 775-737-9001
-----------------------------------------------------
Fax | 775-870-1628
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | MI4093
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------