Provider Demographics
NPI:1619235959
Name:MANNERS, SARA
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:MANNERS
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:PO BOX 1271
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:OK
Mailing Address - Zip Code:74355-1271
Mailing Address - Country:US
Mailing Address - Phone:918-542-2845
Mailing Address - Fax:918-524-2848
Practice Address - Street 1:130 W STEVE OWENS BLVD
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:OK
Practice Address - Zip Code:74354-7629
Practice Address - Country:US
Practice Address - Phone:918-542-2845
Practice Address - Fax:918-542-2848
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-24
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)