Basic Information
| Provider Information | |||||||||
| NPI: | 1174832901 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PAULSEN | ||||||||
| FirstName: | SARAH | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | SLIMMER | ||||||||
| OtherFirstName: | SARAH | ||||||||
| OtherMiddleName: | MARIE | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 4930 NAPLES ST | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921103820 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6192761176 | ||||||||
| FaxNumber: | 6198393741 | ||||||||
| Practice Location | |||||||||
| Address1: | 4930 NAPLES ST | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921103820 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6192761176 | ||||||||
| FaxNumber: | 6198393741 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/28/2010 | ||||||||
| LastUpdateDate: | 02/16/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | CC00172 | MN | N | Behavioral Health & Social Service Providers | Counselor | 106H00000X | 2787 | MN | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 106H00000X | IMF 94647 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.