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General NPI Number Information
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NPI Number | 1134828403
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Entity Type | Organization
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Legal Business Name | SARA PROVENCE LMFT
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Dates
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Enumeration Date | 02/27/2023
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Last Update Date | 03/09/2023
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Provider Practice Location Address
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Address Line | 3455 INGRAHAM ST
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City | SAN DIEGO
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State | CA
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Zip | 92109-6713
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Country | US
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Telephone | 619-723-6004
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Fax |
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Provider Business Mailing Address
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Address Line | 9528 MIRAMAR RD
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City | SAN DIEGO
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State | CA
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Zip | 92126-4533
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | LMFT (THERAPIST)
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Name | SARA PROVENCE
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Credential | LMFT
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Telephone | 619-354-2249
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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