Provider Demographics
NPI:1174662449
Name:MARCK, SARA (SARA MARCK MS LP)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:MARCK
Suffix:
Gender:F
Credentials:SARA MARCK MS LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 W LAKE ST
Mailing Address - Street 2:#320
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55416-4527
Mailing Address - Country:US
Mailing Address - Phone:612-558-9555
Mailing Address - Fax:612-929-9006
Practice Address - Street 1:3100 W LAKE ST
Practice Address - Street 2:#320
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55416-4527
Practice Address - Country:US
Practice Address - Phone:612-558-9555
Practice Address - Fax:612-929-9006
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP 3094103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling