Provider Demographics
NPI:1124586177
Name:POULOS, SARAH (LCSW)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:POULOS
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:PO BOX 845347
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-5347
Mailing Address - Country:US
Mailing Address - Phone:214-645-0624
Mailing Address - Fax:214-645-0078
Practice Address - Street 1:6363 FOREST PARK RD.
Practice Address - Street 2:7TH FL., STE. 749
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-9121
Practice Address - Country:US
Practice Address - Phone:214-645-8500
Practice Address - Fax:214-648-3775
Is Sole Proprietor?:No
Enumeration Date:2019-03-08
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX597851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical