Provider Demographics
NPI:1821599465
Name:KAUSAR, SUMAIRA NA
Entity Type:Individual
Prefix:
First Name:SUMAIRA
Middle Name:NA
Last Name:KAUSAR
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 1:9227 PURPLE SKIES CT
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624-4804
Mailing Address - Country:US
Mailing Address - Phone:916-519-4198
Mailing Address - Fax:
Practice Address - Street 1:9227 PURPLE SKIES CT
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95624-4804
Practice Address - Country:US
Practice Address - Phone:916-519-4198
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-27
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-18-33483103K00000X
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst