Provider Demographics
NPI:1194219543
Name:SERIFOVIC, SEJLA
Entity Type:Individual
Prefix:
First Name:SEJLA
Middle Name:
Last Name:SERIFOVIC
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SEJLA
Other - Middle Name:
Other - Last Name:SERIFOVIC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:340 2ND ST STE 8
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-3651
Mailing Address - Country:US
Mailing Address - Phone:650-374-7255
Mailing Address - Fax:
Practice Address - Street 1:340 2ND ST STE 8
Practice Address - Street 2:
Practice Address - City:LOS ALTOS
Practice Address - State:CA
Practice Address - Zip Code:94022-3651
Practice Address - Country:US
Practice Address - Phone:650-374-7255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-19
Last Update Date:2022-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60567967101YM0800X
CA9598101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health