MEDICARE: LIFE PRACTICE COUNSELING GROUP

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

General Provider Information

NPI Number	:	1285348086
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFE PRACTICE COUNSELING GROUP

Provider Business Mailing Address
First Line	:	3820 AUBURN BLVD STE 100
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95821-2124
Country	:	US
Telephone Number	:	916-300-6576
Fax Number	:	916-514-1621

Provider Business Practice Location Address
First Line	:	2787 GROVE AVE
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95815-1629
Country	:	US
Telephone Number	:	916-300-6576
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	CARISA SALAZAR SHERWOOD
Credential	:	LMFT 48768
Telephone Number	:	916-798-5468

Provider Enumeration Date	:	01/06/2023
Last Update Date	:	01/06/2023

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