Provider Demographics
NPI:1093579112
Name:LECONTE, SARA (MFT)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:LECONTE
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5355 CARTWRIGHT AVE UNIT 321
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91601-5492
Mailing Address - Country:US
Mailing Address - Phone:347-309-0616
Mailing Address - Fax:818-361-7584
Practice Address - Street 1:12610 GLENOAKS BLVD
Practice Address - Street 2:
Practice Address - City:SYLMAR
Practice Address - State:CA
Practice Address - Zip Code:91342-4783
Practice Address - Country:US
Practice Address - Phone:818-361-4111
Practice Address - Fax:818-361-7584
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-08
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty