Provider Demographics
NPI:1558612259
Name:DURHAM, SARA GALE (LPC CANDIDATE)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:GALE
Last Name:DURHAM
Suffix:
Gender:F
Credentials:LPC CANDIDATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 N SHARTEL AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73103-2403
Mailing Address - Country:US
Mailing Address - Phone:405-702-6677
Mailing Address - Fax:405-702-6680
Practice Address - Street 1:1305 N SHARTEL AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73103-2403
Practice Address - Country:US
Practice Address - Phone:405-702-6677
Practice Address - Fax:405-702-6680
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-21
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health