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General NPI Number Information
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NPI Number | 1205296894
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Entity Type | Organization
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Legal Business Name | PSYCHOTHERAPY PRIVATE PRACTICE
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Dates
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Enumeration Date | 02/25/2016
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Last Update Date | 02/25/2016
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Provider Practice Location Address
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Address Line | 410 9TH ST
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City | GOLDEN
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State | CO
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Zip | 80401-1066
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Country | US
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Telephone | 916-346-6248
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Fax |
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Provider Business Mailing Address
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Address Line | 6905 GLADIOLA ST
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City | ARVADA
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State | CO
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Zip | 80004-1094
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Country | US
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Telephone | 916-346-6248
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Fax |
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Authorized Official
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Title or Position | PSYCHOTHERAPIST
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Name | MS. SHARON SAUSTO LASSER
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Credential | MFT
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Telephone | 916-346-6248
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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 | 0000930
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License Number State | CO
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