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General NPI Number Information
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NPI Number | 1336951284
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Entity Type | Individual
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Provider Name | SARAH KOUCHAK-EFTEKHAR
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Gender | Female
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Dates
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Enumeration Date | 01/27/2025
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Last Update Date | 01/27/2025
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Provider Practice Location Address
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Address Line | 6310 SAN VICENTE BLVD STE 410
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City | LOS ANGELES
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State | CA
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Zip | 90048-5457
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Country | US
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Telephone | 312-929-5261
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Fax |
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Provider Business Mailing Address
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Address Line | 4642 WILLIS AVE APT 303
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City | SHERMAN OAKS
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State | CA
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Zip | 91403-2651
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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 |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | APCC16979
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License Number State | CA
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