Basic Information
| Provider Information | |||||||||
| NPI: | 1710651211 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SAGUARO FAMILY COUNSELING, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2355 WESTWOOD BLVD # 919 | ||||||||
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| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900642109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4802391348 | ||||||||
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| Practice Location | |||||||||
| Address1: | 10944 ROSE AVE APT 7 | ||||||||
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| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900345385 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4802391348 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/06/2021 | ||||||||
| LastUpdateDate: | 08/06/2021 | ||||||||
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| AuthorizedOfficialLastName: | KAHN | ||||||||
| AuthorizedOfficialFirstName: | REBECCA | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRACTICE OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4802391348 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LMFT, PMH-C | ||||||||
| NPICertificationDate: | 08/06/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.