Provider Demographics
NPI:1164015095
Name:EVANS, SARA L (MA, LMHC)
Entity Type:Individual
Prefix:MS
First Name:SARA
Middle Name:L
Last Name:EVANS
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4502 W LAKE POTOMAC VW APT B
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46140-7355
Mailing Address - Country:US
Mailing Address - Phone:765-729-3035
Mailing Address - Fax:
Practice Address - Street 1:5124 REFORMATORY RD
Practice Address - Street 2:
Practice Address - City:PENDLETON
Practice Address - State:IN
Practice Address - Zip Code:46064-8767
Practice Address - Country:US
Practice Address - Phone:765-778-8011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-11
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39003726A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN39003726AOtherPLA