Provider Demographics
NPI:1326649153
Name:SPIVEY, SARA JEAN (MS, LAC)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:JEAN
Last Name:SPIVEY
Suffix:
Gender:F
Credentials:MS, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13460 N 94TH DR STE M1
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-4247
Mailing Address - Country:US
Mailing Address - Phone:623-974-3333
Mailing Address - Fax:
Practice Address - Street 1:13460 N 94TH DR STE M1
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4247
Practice Address - Country:US
Practice Address - Phone:623-974-3333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-06
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-16245101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health