Provider Demographics
NPI:1801852496
Name:LITTLE, SARA S (PHD)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:S
Last Name:LITTLE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4045 AUSTINS ESTATES DR
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77808-7301
Mailing Address - Country:US
Mailing Address - Phone:401-578-1554
Mailing Address - Fax:662-567-1007
Practice Address - Street 1:4045 AUSTINS ESTATES DR
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77808-7301
Practice Address - Country:US
Practice Address - Phone:203-397-6165
Practice Address - Fax:662-567-1007
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-24
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPS00574103T00000X
TX38398103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist