Provider Demographics
NPI:1376152702
Name:DEESE, SARA MARIE (MCAP,LMHC, LPC, LPCC)
Entity Type:Individual
Prefix:MS
First Name:SARA
Middle Name:MARIE
Last Name:DEESE
Suffix:
Gender:F
Credentials:MCAP,LMHC, LPC, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7316 OTTER CREEK DR
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-4000
Mailing Address - Country:US
Mailing Address - Phone:727-410-9281
Mailing Address - Fax:
Practice Address - Street 1:7316 OTTER CREEK DR
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34655-4000
Practice Address - Country:US
Practice Address - Phone:727-304-3842
Practice Address - Fax:727-291-7623
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-31
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4007101YM0800X
SC9119101YM0800X
MO2023032955101YM0800X
WI10495-125101YP2500X
FLMH18260101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional