Provider Demographics
NPI:1699181107
Name:WILBURN, SARAH (MED, BCBA)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:
Last Name:WILBURN
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:524 JACOBS LN
Mailing Address - Street 2:
Mailing Address - City:LA VERNIA
Mailing Address - State:TX
Mailing Address - Zip Code:78121-5695
Mailing Address - Country:US
Mailing Address - Phone:512-757-5101
Mailing Address - Fax:
Practice Address - Street 1:524 JACOBS LN
Practice Address - Street 2:
Practice Address - City:LA VERNIA
Practice Address - State:TX
Practice Address - Zip Code:78121-5695
Practice Address - Country:US
Practice Address - Phone:512-757-5101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-03
Last Update Date:2014-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBACB231492103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst