Provider Demographics
NPI:1306394028
Name:BRINKLEY, SARAH M (LPCIT)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:M
Last Name:BRINKLEY
Suffix:
Gender:F
Credentials:LPCIT
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:M
Other - Last Name:KUMMER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:W175N11120 STONEWOOD DR
Mailing Address - Street 2:ATTN: LINDA RANGEL
Mailing Address - City:GERMANTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53022-6511
Mailing Address - Country:US
Mailing Address - Phone:800-438-1772
Mailing Address - Fax:262-293-9737
Practice Address - Street 1:757 S MAIN ST STE 8
Practice Address - Street 2:
Practice Address - City:FOND DU LAC
Practice Address - State:WI
Practice Address - Zip Code:54935-5708
Practice Address - Country:US
Practice Address - Phone:800-438-1772
Practice Address - Fax:262-345-5562
Is Sole Proprietor?:No
Enumeration Date:2016-09-12
Last Update Date:2019-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3224-226101YP2500X
WI7573-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional