Provider Demographics
NPI:1508289174
Name:BIVANS, SARA (PHD)
Entity Type:Individual
Prefix:DR
First Name:SARA
Middle Name:
Last Name:BIVANS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19562 VENTURA BLVD
Mailing Address - Street 2:SUITE 233
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-2955
Mailing Address - Country:US
Mailing Address - Phone:310-810-8216
Mailing Address - Fax:
Practice Address - Street 1:19562 VENTURA BLVD
Practice Address - Street 2:SUITE 233
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-2955
Practice Address - Country:US
Practice Address - Phone:310-709-5128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-01
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALR117041103TA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)