Provider Demographics
NPI:1134685852
Name:KOUZI, SARAH
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:KOUZI
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 1:3039 FOREST CREEK CT
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-5216
Mailing Address - Country:US
Mailing Address - Phone:949-310-1685
Mailing Address - Fax:
Practice Address - Street 1:3039 FOREST CREEK CT
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-5216
Practice Address - Country:US
Practice Address - Phone:949-310-1685
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-18
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4101007480106H00000X
CARBT-19-78648106S00000X
CA145518106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician