Provider Demographics
NPI:1528187945
Name:POULSON, SARAH K (MA COUN PSYCH)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:K
Last Name:POULSON
Suffix:
Gender:F
Credentials:MA COUN PSYCH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2720 DALE AVE
Mailing Address - Street 2:
Mailing Address - City:CERES
Mailing Address - State:CA
Mailing Address - Zip Code:95307-2715
Mailing Address - Country:US
Mailing Address - Phone:209-531-1787
Mailing Address - Fax:
Practice Address - Street 1:2720 DALE AVE
Practice Address - Street 2:
Practice Address - City:CERES
Practice Address - State:CA
Practice Address - Zip Code:95307-2715
Practice Address - Country:US
Practice Address - Phone:209-531-1787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional