Provider Demographics
NPI:1568641215
Name:HUNT, SARA AILEEN (LCSW CACIII)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:AILEEN
Last Name:HUNT
Suffix:
Gender:F
Credentials:LCSW CACIII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 555
Mailing Address - Street 2:
Mailing Address - City:BAYFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:81122-0555
Mailing Address - Country:US
Mailing Address - Phone:970-749-0885
Mailing Address - Fax:
Practice Address - Street 1:765 E COLLEGE DR
Practice Address - Street 2:UNIT 2
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-5547
Practice Address - Country:US
Practice Address - Phone:970-749-0885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-30
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO13251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical