1255687893 NPI number — SARAH KATHERINE BURKLE LMFT 88866

Table of content: SARAH KATHERINE BURKLE LMFT 88866 (NPI 1255687893)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255687893 NPI number — SARAH KATHERINE BURKLE LMFT 88866

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BURKLE
Provider First Name:
SARAH
Provider Middle Name:
KATHERINE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LMFT 88866
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WORRELL
Provider Other First Name:
SARAH
Provider Other Middle Name:
KATHERINE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LMFT 88866
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1255687893
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/17/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
314 HATHEWAY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOUNTAIN HOUSE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95391-1024
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
925-523-9371
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
314 HATHEWAY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNTAIN HOUSE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95391-1024
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
925-523-9371
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/01/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  88866 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com