Provider Demographics
NPI:1861853483
Name:LEIST, SARAH ANN (LLPC)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:ANN
Last Name:LEIST
Suffix:
Gender:F
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5675 CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:BOYNE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49712-9350
Mailing Address - Country:US
Mailing Address - Phone:231-622-9640
Mailing Address - Fax:
Practice Address - Street 1:5675 CHURCH RD
Practice Address - Street 2:
Practice Address - City:BOYNE CITY
Practice Address - State:MI
Practice Address - Zip Code:49712-9350
Practice Address - Country:US
Practice Address - Phone:231-622-9640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-09
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401014485101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health