Provider Demographics
NPI:1821648999
Name:MARTIN, SARA DESIREE (LPC)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:DESIREE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8426 WOLF DR
Mailing Address - Street 2:
Mailing Address - City:PHELAN
Mailing Address - State:CA
Mailing Address - Zip Code:92371-4519
Mailing Address - Country:US
Mailing Address - Phone:760-684-1696
Mailing Address - Fax:
Practice Address - Street 1:6863 JOHNSON ST
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80004-2948
Practice Address - Country:US
Practice Address - Phone:720-421-6399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-19
Last Update Date:2023-11-14
Deactivation Date:2020-09-09
Deactivation Code:
Reactivation Date:2020-09-16
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program