Provider Demographics
NPI:1710630587
Name:LANDON, SARAYA
Entity Type:Individual
Prefix:
First Name:SARAYA
Middle Name:
Last Name:LANDON
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 1:169 MASON ST STE 300
Mailing Address - Street 2:
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-4483
Mailing Address - Country:US
Mailing Address - Phone:707-463-3300
Mailing Address - Fax:
Practice Address - Street 1:169 MASON ST STE 300
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-4483
Practice Address - Country:US
Practice Address - Phone:707-463-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-01
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225400000X, 225400000X
CA16010101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional