Provider Demographics
NPI:1376074625
Name:MARX, SARA MITTERHOLZER (LCPC, NCC)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:MITTERHOLZER
Last Name:MARX
Suffix:
Gender:F
Credentials:LCPC, NCC
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:
Other - Last Name:MITTERHOLZER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1049 WILMETTE TER
Mailing Address - Street 2:
Mailing Address - City:LAKE ZURICH
Mailing Address - State:IL
Mailing Address - Zip Code:60047-2163
Mailing Address - Country:US
Mailing Address - Phone:419-302-3565
Mailing Address - Fax:
Practice Address - Street 1:1155 IL-22
Practice Address - Street 2:
Practice Address - City:LAKE ZURICH
Practice Address - State:IL
Practice Address - Zip Code:60047
Practice Address - Country:US
Practice Address - Phone:847-540-8380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-27
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.010451101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional