Provider Demographics
NPI:1871852947
Name:ST. CYR, SARAH (MED, LPC)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:ST. CYR
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1219 E SOUTH 11TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79602-4283
Mailing Address - Country:US
Mailing Address - Phone:325-676-2039
Mailing Address - Fax:325-670-9793
Practice Address - Street 1:1219 E SOUTH 11TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79602-4283
Practice Address - Country:US
Practice Address - Phone:325-676-2039
Practice Address - Fax:325-670-9793
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-10
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67064101YP2500X
1-12-12073103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2939696Medicaid