Provider Demographics
NPI:1407120041
Name:BRUNGARDT, SARA N (LPC)
Entity Type:Individual
Prefix:DR
First Name:SARA
Middle Name:N
Last Name:BRUNGARDT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10245 E VIA LINDA STE 225
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-5345
Mailing Address - Country:US
Mailing Address - Phone:480-687-3435
Mailing Address - Fax:480-687-7061
Practice Address - Street 1:10245 E VIA LINDA STE 225
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-5345
Practice Address - Country:US
Practice Address - Phone:480-687-3435
Practice Address - Fax:480-687-7061
Is Sole Proprietor?:No
Enumeration Date:2012-02-29
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional