Provider Demographics
NPI:1346028370
Name:SERVIAM, LLC
Entity Type:Organization
Organization Name:SERVIAM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEONI
Authorized Official - Middle Name:
Authorized Official - Last Name:SABLAN
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:209-596-3873
Mailing Address - Street 1:22515 E MUNOZ ST
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-9152
Mailing Address - Country:US
Mailing Address - Phone:209-596-3873
Mailing Address - Fax:
Practice Address - Street 1:22515 E MUNOZ ST
Practice Address - Street 2:
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85142-9152
Practice Address - Country:US
Practice Address - Phone:209-596-3873
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-20
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty