Provider Demographics
NPI:1699024315
Name:METTS, SARA B (EDS, PLPC)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:B
Last Name:METTS
Suffix:
Gender:F
Credentials:EDS, PLPC
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:B
Other - Last Name:RANDALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:EDS, PLPC
Mailing Address - Street 1:705 ILLINOIS AVE
Mailing Address - Street 2:22
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64801-5067
Mailing Address - Country:US
Mailing Address - Phone:417-627-9994
Mailing Address - Fax:417-627-9995
Practice Address - Street 1:705 ILLINOIS AVE
Practice Address - Street 2:22
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64801-5067
Practice Address - Country:US
Practice Address - Phone:417-627-9994
Practice Address - Fax:417-627-9995
Is Sole Proprietor?:No
Enumeration Date:2012-09-10
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012030032101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional