Provider Demographics
NPI:1598364747
Name:SPIESS, SARA
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:SPIESS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2042 GROUND SQUIRREL DR
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-4025
Mailing Address - Country:US
Mailing Address - Phone:636-373-4130
Mailing Address - Fax:
Practice Address - Street 1:447 3RD AVE N STE 204
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-3245
Practice Address - Country:US
Practice Address - Phone:727-214-0428
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-20
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH19457101YM0800X
FLIMH16792101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health