Provider Demographics
NPI:1760008122
Name:TRIBBLE, SARA (CSWI)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:TRIBBLE
Suffix:
Gender:F
Credentials:CSWI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3340 TOPAZ ST STE 170
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-3906
Mailing Address - Country:US
Mailing Address - Phone:702-755-1183
Mailing Address - Fax:
Practice Address - Street 1:3340 TOPAZ ST STE 170
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-3906
Practice Address - Country:US
Practice Address - Phone:702-268-7604
Practice Address - Fax:702-442-8840
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-22
Last Update Date:2022-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 101YM0800X, 225400000X
NVIC20501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner