Provider Demographics
NPI:1437599669
Name:DESHAW, SARA ELIZABETH (LPC)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:ELIZABETH
Last Name:DESHAW
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 1:1901 DUTTON DR
Mailing Address - Street 2:SUITE E
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666-7573
Mailing Address - Country:US
Mailing Address - Phone:512-396-7695
Mailing Address - Fax:512-396-7633
Practice Address - Street 1:1901 DUTTON DR
Practice Address - Street 2:SUITE E
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-7573
Practice Address - Country:US
Practice Address - Phone:512-396-7695
Practice Address - Fax:512-396-7633
Is Sole Proprietor?:No
Enumeration Date:2013-07-02
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67965101Y00000X
TX12149101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX065337001Medicaid