Provider Demographics
NPI:1942767215
Name:HOUGH, SARA
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:HOUGH
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 1:11166 ORVILLE ST
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-5381
Mailing Address - Country:US
Mailing Address - Phone:310-560-3668
Mailing Address - Fax:
Practice Address - Street 1:2001 S BARRINGTON AVE STE 215
Practice Address - Street 2:
Practice Address - City:WEST LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-5385
Practice Address - Country:US
Practice Address - Phone:310-560-3668
Practice Address - Fax:424-500-2073
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-22
Last Update Date:2019-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY16700103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist