Individual provider Active NPI

Sara Rose Van Koningsveld

  • Professional Counselor
  • Glendale, CA
National Provider Identifier
1104101310
Registry record updated Apr 20, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
LPCC8233 Issued in CA
Practice address
225 W Broadway Ste 155
Glendale, CA 91204-1332
Phone
(818) 441-7800
NPI assigned
Oct 19, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X 13952768-6004 UT
Professional Counselor 101YP2500X LPCC8233 CA Primary
Dance Therapist 225600000X BCDMT1207
Mental Health Counselor 101YM0800X LPC10289 WI

Addresses

Primary practice location

225 W Broadway Ste 155
Glendale, CA 91204-1332

Mailing address

PO Box 642900
Los Angeles, CA 90064-8314

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240910003468 CA Practitioner - Mental Health Counselor 9638619240 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
13952768-6004UTMDMental Health Counselor
LPC10289WIMDMental Health Counselor
LPCC8233CAMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Silver Lake Psychology Inc. CurrentSince Apr 8, 2025 Accepting new patients
Meridian Counseling CurrentSince Jul 1, 2024 Accepting new patients
Wholeyou Integrative Health and Professional Clinical Counseling, Inc. CurrentSince Feb 25, 2024 Accepting new patients
Counseling4Kids PastSince Nov 9, 2021 Accepting new patients

Locations

11835 W Olympic Blvd
Ste 815E
Los Angeles, CA 90064
Phone (323) 332-9905

2301 Hyperion Ave
#A
Los Angeles, CA 90027
Phone (310) 726-3890

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1318982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1776643200000",
    "number": "1104101310",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 642900",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900648314"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "225 W BROADWAY STE 155",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912041332",
            "telephone_number": "818-441-7800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAN KONINGSVELD",
        "first_name": "SARA",
        "middle_name": "ROSE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-10-19",
        "last_updated": "2026-04-20",
        "certification_date": "2026-04-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "UT",
            "license": "13952768-6004",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "CA",
            "license": "LPCC8233",
            "primary": true
        },
        {
            "code": "225600000X",
            "taxonomy_group": "",
            "desc": "Dance Therapist",
            "state": null,
            "license": "BCDMT1207",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "WI",
            "license": "LPC10289",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glendale, CA

Sources for this page

Verify at the official NPI Registry.