Provider Demographics
NPI:1043403090
Name:GROTJOHN, SARA BETH (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SARA
Middle Name:BETH
Last Name:GROTJOHN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 HIGHWAY 574 WEST
Mailing Address - Street 2:
Mailing Address - City:GOLDTHWAITE
Mailing Address - State:TX
Mailing Address - Zip Code:76844-0549
Mailing Address - Country:US
Mailing Address - Phone:325-938-5518
Mailing Address - Fax:
Practice Address - Street 1:2500 FM 2126
Practice Address - Street 2:
Practice Address - City:BROWNWOOD
Practice Address - State:TX
Practice Address - Zip Code:76802-3646
Practice Address - Country:US
Practice Address - Phone:325-643-3152
Practice Address - Fax:325-643-5721
Is Sole Proprietor?:No
Enumeration Date:2007-08-23
Last Update Date:2007-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX077881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical