Provider Demographics
NPI:1225542400
Name:SAKURA ASSESSMENT AND THERAPY, LLC
Entity Type:Organization
Organization Name:SAKURA ASSESSMENT AND THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:VAIL
Authorized Official - Last Name:WILLIAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:207-522-5243
Mailing Address - Street 1:1810 W 300 N
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-9541
Mailing Address - Country:US
Mailing Address - Phone:207-522-5243
Mailing Address - Fax:
Practice Address - Street 1:1810 W 300 N
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-9541
Practice Address - Country:US
Practice Address - Phone:207-522-5243
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-27
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8416054-2501103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty