Provider Demographics
NPI:1710460621
Name:ROE, SARA A
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:A
Last Name:ROE
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 1:123 SOUTHRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:RED OAK
Mailing Address - State:TX
Mailing Address - Zip Code:75154-5811
Mailing Address - Country:US
Mailing Address - Phone:469-569-7864
Mailing Address - Fax:
Practice Address - Street 1:1162 W PIONEER PKWY
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76013-6367
Practice Address - Country:US
Practice Address - Phone:682-308-0832
Practice Address - Fax:682-308-0835
Is Sole Proprietor?:No
Enumeration Date:2018-09-07
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPBSDFI020I7SARO106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician