Provider Demographics
NPI:1235761248
Name:COUTURE, SARAH LISA (CPC)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:LISA
Last Name:COUTURE
Suffix:
Gender:F
Credentials:CPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1017 HARDING RD
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:WA
Mailing Address - Zip Code:98520-6423
Mailing Address - Country:US
Mailing Address - Phone:360-819-6478
Mailing Address - Fax:
Practice Address - Street 1:3033 INGRAM ST STE 3033-B
Practice Address - Street 2:
Practice Address - City:HOQUIAM
Practice Address - State:WA
Practice Address - Zip Code:98550-4410
Practice Address - Country:US
Practice Address - Phone:360-819-6478
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-07
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG61040406101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1285155366Medicaid