Provider Demographics
NPI:1760606347
Name:KNELL, SARAH SHAW (LCPC)
Entity Type:Individual
Prefix:MS
First Name:SARAH
Middle Name:SHAW
Last Name:KNELL
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6758
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59771-6758
Mailing Address - Country:US
Mailing Address - Phone:406-586-5161
Mailing Address - Fax:
Practice Address - Street 1:321 E MAIN ST STE 206
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-4731
Practice Address - Country:US
Practice Address - Phone:406-586-5161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT726101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional