Provider Demographics
NPI:1881046944
Name:SARGENT, JASON (CADC II)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:SARGENT
Suffix:
Gender:M
Credentials:CADC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1633 E MAPLE AVE APT 5
Mailing Address - Street 2:
Mailing Address - City:EL SEGUNDO
Mailing Address - State:CA
Mailing Address - Zip Code:90245-3317
Mailing Address - Country:US
Mailing Address - Phone:310-780-0611
Mailing Address - Fax:
Practice Address - Street 1:9100 S SEPULVEDA BLVD STE 105
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-4849
Practice Address - Country:US
Practice Address - Phone:310-644-3659
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-12
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAII056330518101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)