Provider Demographics
NPI:1093861312
Name:FAWCETT, SARAH ESTELLE (MA)
Entity Type:Individual
Prefix:MS
First Name:SARAH
Middle Name:ESTELLE
Last Name:FAWCETT
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:RUTH
Other - Middle Name:ESTELLE
Other - Last Name:FAWCETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:PO BOX 682
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-0682
Mailing Address - Country:US
Mailing Address - Phone:830-248-1018
Mailing Address - Fax:830-248-1323
Practice Address - Street 1:470 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-2338
Practice Address - Country:US
Practice Address - Phone:830-248-1018
Practice Address - Fax:830-248-1323
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18495101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional