Provider Demographics
NPI:1033997911
Name:ANDERSON, SARAH WILLAMETTE (LPC)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:WILLAMETTE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5409 TEMECULA RD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-6271
Mailing Address - Country:US
Mailing Address - Phone:817-723-4661
Mailing Address - Fax:
Practice Address - Street 1:5409 TEMECULA RD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-6271
Practice Address - Country:US
Practice Address - Phone:817-723-4661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-20
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67132101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional