Provider Demographics
NPI:1689236861
Name:LARSEN, SARAH NASSER (MED ,LPC,LPCC)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:NASSER
Last Name:LARSEN
Suffix:
Gender:F
Credentials:MED ,LPC,LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1836 PORT TIFFIN PL
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7121
Mailing Address - Country:US
Mailing Address - Phone:949-274-2521
Mailing Address - Fax:
Practice Address - Street 1:4060 CAMPUS DR STE 110
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2205
Practice Address - Country:US
Practice Address - Phone:949-274-2521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-08
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6082101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional