Provider Demographics
NPI:1780128793
Name:SAKURADA, GRACE MARIE (MS, LMFT)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:MARIE
Last Name:SAKURADA
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 CREEKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:WILLITS
Mailing Address - State:CA
Mailing Address - Zip Code:95490-3611
Mailing Address - Country:US
Mailing Address - Phone:916-879-3054
Mailing Address - Fax:
Practice Address - Street 1:104 W MENDOCINO AVE
Practice Address - Street 2:
Practice Address - City:WILLITS
Practice Address - State:CA
Practice Address - Zip Code:95490-3412
Practice Address - Country:US
Practice Address - Phone:916-879-3054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-09
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFTI 96796106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist