Provider Demographics
NPI:1215200829
Name:EUBANKS, SARAH JANE (MA, LPC INTERN)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:JANE
Last Name:EUBANKS
Suffix:
Gender:F
Credentials:MA, LPC INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2099 N COLLINS BLVD
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-2698
Mailing Address - Country:US
Mailing Address - Phone:972-437-4698
Mailing Address - Fax:
Practice Address - Street 1:2099 N COLLINS BLVD
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-2698
Practice Address - Country:US
Practice Address - Phone:972-437-4698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-13
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX68384101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor