Provider Demographics
NPI:1740326792
Name:SULLIVAN, SARA MCGOWAN (LPC LICENSED PROFESS)
Entity type:Individual
Prefix:MS
First Name:SARA
Middle Name:MCGOWAN
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:LPC LICENSED PROFESS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8102 BURNING HILLS DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77071
Mailing Address - Country:US
Mailing Address - Phone:713-773-0787
Mailing Address - Fax:
Practice Address - Street 1:10701 CORPORATE DRIVE
Practice Address - Street 2:SUITE # 220
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477
Practice Address - Country:US
Practice Address - Phone:281-507-9150
Practice Address - Fax:281-494-4307
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12918101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor