Provider Demographics
NPI:1790049385
Name:MANSILLA, SARA MCGEE (BCABA)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:MCGEE
Last Name:MANSILLA
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17547 SILVERWOOD WAY # 14
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-7019
Mailing Address - Country:US
Mailing Address - Phone:504-884-2679
Mailing Address - Fax:
Practice Address - Street 1:17547 SILVERWOOD WAY # 14
Practice Address - Street 2:
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-7019
Practice Address - Country:US
Practice Address - Phone:504-884-2679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-27
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst