MEDICARE: SARAH CALLOW-ST. GEORGE M.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	PCCI783	CA

General Provider Information

NPI Number	:	1043686983
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH CALLOW-ST. GEORGE M.A.

Provider Business Mailing Address
First Line	:	405 20TH ST APT B
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92648-3858
Country	:	US
Telephone Number	:	714-323-6163
Fax Number	:

Provider Business Practice Location Address
First Line	:	18811 HUNTINGTON ST STE 200
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92648-6003
Country	:	US
Telephone Number	:	714-323-6163
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/14/2015
Last Update Date	:	08/14/2015

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