Provider Demographics
NPI:1437431913
Name:THIBAULT, SARAH WINFIELD (LMHP, LMFT, LADC)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:WINFIELD
Last Name:THIBAULT
Suffix:
Gender:F
Credentials:LMHP, LMFT, LADC
Other - Prefix:MS
Other - First Name:SARAH
Other - Middle Name:WINFIELD
Other - Last Name:MEYERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 5858
Mailing Address - Street 2:3532 WEST CAPITAL AVE
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68845
Mailing Address - Country:US
Mailing Address - Phone:308-381-7487
Mailing Address - Fax:308-381-2712
Practice Address - Street 1:3532 WEST CAPITAL AVE
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68845
Practice Address - Country:US
Practice Address - Phone:308-381-7487
Practice Address - Fax:308-381-2712
Is Sole Proprietor?:No
Enumeration Date:2011-09-12
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE9495101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE092619Medicaid