Provider Demographics
NPI:1306188917
Name:SARA A CANTU CORP
Entity Type:Organization
Organization Name:SARA A CANTU CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SARA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:CANTU
Authorized Official - Suffix:
Authorized Official - Credentials:LPC-S RPT-S
Authorized Official - Phone:214-288-0202
Mailing Address - Street 1:401 MEADOWBROOK DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76010-2035
Mailing Address - Country:US
Mailing Address - Phone:214-288-0202
Mailing Address - Fax:817-473-7787
Practice Address - Street 1:1751 BROAD PARK CIR S
Practice Address - Street 2:SUITE 207
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-7826
Practice Address - Country:US
Practice Address - Phone:214-288-0202
Practice Address - Fax:817-473-7787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-21
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
1285934711OtherNPI1