Provider Demographics
NPI:1275992281
Name:SEXTON, SARAH ELIZABETH
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:ELIZABETH
Last Name:SEXTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1313 N 16TH AVE
Mailing Address - Street 2:
Mailing Address - City:DURANT
Mailing Address - State:OK
Mailing Address - Zip Code:74701-2134
Mailing Address - Country:US
Mailing Address - Phone:580-634-2332
Mailing Address - Fax:580-634-2338
Practice Address - Street 1:317 N MAUPIN RD
Practice Address - Street 2:
Practice Address - City:COLBERT
Practice Address - State:OK
Practice Address - Zip Code:74733-1550
Practice Address - Country:US
Practice Address - Phone:580-579-0443
Practice Address - Fax:580-931-3119
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-18
Last Update Date:2020-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101Y00000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1275992281Medicaid