Provider Demographics
NPI:1487916300
Name:MORTENSEN, SARAH (LMFT)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:MORTENSEN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2445 OZARK DR
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95304-5884
Mailing Address - Country:US
Mailing Address - Phone:760-600-0397
Mailing Address - Fax:
Practice Address - Street 1:2445 OZARK DR
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95304-5884
Practice Address - Country:US
Practice Address - Phone:760-600-0397
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-15
Last Update Date:2021-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA85498106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist