MEDICARE: SUSTAINABLE SELF INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YM0800X	Mental Health Counselor
2	261QM0850X	Adult Mental Health Clinic/Center
3	261Q00000X	Clinic/Center
4	320800000X	Mental Illness Community Based Residential Treatment Facility
5	261QR0800X	Recovery Care Clinic/Center
6	261QM0855X	Adolescent and Children Mental Health Clinic/Center
7	251S00000X	Community/Behavioral Health Agency
8	261QC1800X	Corporate Health Clinic/Center
9	324500000X	Substance Abuse Rehabilitation Facility
10	101YP2500X	Professional Counselor
11	405300000X	Prevention Professional
12	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1578278198
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUSTAINABLE SELF INC

Provider Business Mailing Address
First Line	:	2828 NEWELL ST STE 6
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90039-3899
Country	:	US
Telephone Number	:	650-279-5857
Fax Number	:

Provider Business Practice Location Address
First Line	:	2828 NEWELL ST STE 6
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90039-3899
Country	:	US
Telephone Number	:	650-279-5857
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. KATELYN LEHMAN
Credential	:	PH.D.
Telephone Number	:	909-571-3178

Provider Enumeration Date	:	01/18/2023
Last Update Date	:	02/04/2026

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Directions to “SUSTAINABLE SELF INC ” Practice Location

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