Provider Demographics
NPI:1639564131
Name:SANSON, SARA (LMHP, MSW)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:SANSON
Suffix:
Gender:F
Credentials:LMHP, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 15TH AVE
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68845-6586
Mailing Address - Country:US
Mailing Address - Phone:024-469-2409
Mailing Address - Fax:
Practice Address - Street 1:15 W 22ND ST
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68847
Practice Address - Country:US
Practice Address - Phone:308-224-0596
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-01
Last Update Date:2018-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE69661041C0700X
NE10457101YM0800X
NE17631041C0700X
NE5134101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical