Provider Demographics
NPI:1558036087
Name:CHLEBOUN, SARA MARIE
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:MARIE
Last Name:CHLEBOUN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12966 EUCLID ST STE 280
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92840-9202
Mailing Address - Country:US
Mailing Address - Phone:657-251-9912
Mailing Address - Fax:714-823-4777
Practice Address - Street 1:12966 EUCLID ST STE 280
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92840-9202
Practice Address - Country:US
Practice Address - Phone:657-251-9912
Practice Address - Fax:714-823-4777
Is Sole Proprietor?:No
Enumeration Date:2021-08-16
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA109299104100000X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker