Provider Demographics
NPI:1881907079
Name:JOHNSON, SARAH MCCLOUD
Entity type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:MCCLOUD
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:SARAH
Other - Middle Name:MCCLOUD
Other - Last Name:POLITZER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:714 W, MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945
Mailing Address - Country:US
Mailing Address - Phone:530-477-9800
Mailing Address - Fax:530-477-9803
Practice Address - Street 1:714 W, MAIN ST.
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945
Practice Address - Country:US
Practice Address - Phone:530-477-9800
Practice Address - Fax:530-477-9803
Is Sole Proprietor?:No
Enumeration Date:2010-07-16
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA72666106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health