Provider Demographics
NPI: | 1700015492 |
---|---|
Name: | PERRY, SARAH A (MA, LPC) |
Entity Type: | Individual |
Prefix: | MISS |
First Name: | SARAH |
Middle Name: | A |
Last Name: | PERRY |
Suffix: | |
Gender: | F |
Credentials: | MA, LPC |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 355 E CAMPUS VIEW BLVD |
Mailing Address - Street 2: | SUITE 240 |
Mailing Address - City: | COLUMBUS |
Mailing Address - State: | OH |
Mailing Address - Zip Code: | 43235-5616 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 614-310-1234 |
Mailing Address - Fax: | 614-310-1237 |
Practice Address - Street 1: | 355 E CAMPUS VIEW BLVD |
Practice Address - Street 2: | SUITE 240 |
Practice Address - City: | COLUMBUS |
Practice Address - State: | OH |
Practice Address - Zip Code: | 43235-5616 |
Practice Address - Country: | US |
Practice Address - Phone: | 614-310-1234 |
Practice Address - Fax: | 614-310-1237 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2009-07-02 |
Last Update Date: | 2010-10-20 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
OH | C.0700386 | 101YM0800X, 101YP2500X, 106H00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 101YP2500X | Behavioral Health & Social Service Providers | Counselor | Professional |
No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No | 106H00000X | Behavioral Health & Social Service Providers | Marriage & Family Therapist |