Provider Demographics
NPI:1437526522
Name:SHAH, SARAH SUZANNE (MA, LMHC, NCC)
Entity Type:Individual
Prefix:MS
First Name:SARAH
Middle Name:SUZANNE
Last Name:SHAH
Suffix:
Gender:F
Credentials:MA, LMHC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3901 LOUISIANA BLVD NE STE C
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-1448
Mailing Address - Country:US
Mailing Address - Phone:505-916-5186
Mailing Address - Fax:
Practice Address - Street 1:3901 LOUISIANA BLVD NE STE B&C
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-1577
Practice Address - Country:US
Practice Address - Phone:505-916-5186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-25
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
NMCMH0203921101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst