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NPI Code Detail

MEDICARE: SARA ROSE VAN KONINGSVELD

MEDICARE: SARA ROSE VAN KONINGSVELD
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
1101YM0800XMental Health CounselorLPC10289WI
2225600000XDance TherapistBCDMT1207
3101YP2500XProfessional CounselorLPCC8233CA

General Provider Information

NPI Number : 1104101310
Entity Type Code : Individual
Provider Name (Legal Business Name) : SARA ROSE VAN KONINGSVELD
Provider Business Mailing Address
First Line : PO BOX 642900
Second Line :
City : LOS ANGELES
State : CA
Zip : 90064-8314
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 11835 W OLYMPIC BLVD STE 815E
Second Line :
City : LOS ANGELES
State : CA
Zip : 90064-5056
Country : US
Telephone Number : 323-332-9905
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/19/2011
Last Update Date : 02/18/2024

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Directions to “ SARA ROSE VAN KONINGSVELD ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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