Provider Demographics
NPI:1619108651
Name:HALLBERG, SARA (LPC, NCC)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:HALLBERG
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 HIGHWAY MM
Mailing Address - Street 2:
Mailing Address - City:HANNIBAL
Mailing Address - State:MO
Mailing Address - Zip Code:63401-3602
Mailing Address - Country:US
Mailing Address - Phone:573-221-2111
Mailing Address - Fax:573-221-2123
Practice Address - Street 1:3700 HIGHWAY MM
Practice Address - Street 2:
Practice Address - City:HANNIBAL
Practice Address - State:MO
Practice Address - Zip Code:63401-3602
Practice Address - Country:US
Practice Address - Phone:573-221-2111
Practice Address - Fax:573-221-2123
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-06
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006009254101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional