Provider Demographics
NPI:1154488369
Name:SARY, MEREDITH RENE (LPC)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:RENE
Last Name:SARY
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 1:3024 W LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615-3773
Mailing Address - Country:US
Mailing Address - Phone:309-688-3050
Mailing Address - Fax:309-688-3052
Practice Address - Street 1:3024 W LAKE AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61615-3773
Practice Address - Country:US
Practice Address - Phone:309-688-3050
Practice Address - Fax:309-688-3052
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional