Provider Demographics
NPI:1609378074
Name:GALLANT, SARA R (LMFT)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:R
Last Name:GALLANT
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4709 GOLF RD STE 1150
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-1252
Mailing Address - Country:US
Mailing Address - Phone:312-213-8802
Mailing Address - Fax:
Practice Address - Street 1:4709 GOLF RD STE 1150
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-1252
Practice Address - Country:US
Practice Address - Phone:312-213-8802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-01
Last Update Date:2022-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL166.001417106H00000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist