Provider Demographics
NPI:1568938686
Name:HARPER, SARA ANN MOODY (LCSW)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:ANN MOODY
Last Name:HARPER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:ANN
Other - Last Name:MOODY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:3112 40TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79413-2724
Mailing Address - Country:US
Mailing Address - Phone:804-704-3666
Mailing Address - Fax:
Practice Address - Street 1:3112 40TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79413-2724
Practice Address - Country:US
Practice Address - Phone:804-704-3666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-16
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20160215301041C0700X
VA09040089301041C0700X
TX667341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical