Provider Demographics
NPI:1922184142
Name:GODINEZ, SARA EMILY (LMLP)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:EMILY
Last Name:GODINEZ
Suffix:
Gender:F
Credentials:LMLP
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:EMILY
Other - Last Name:PHILLIPS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMLP
Mailing Address - Street 1:200 MAINE
Mailing Address - Street 2:STE A
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66044-1390
Mailing Address - Country:US
Mailing Address - Phone:785-843-9192
Mailing Address - Fax:785-843-6744
Practice Address - Street 1:200 MAINE
Practice Address - Street 2:STE A
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66044-1390
Practice Address - Country:US
Practice Address - Phone:785-843-9192
Practice Address - Fax:785-843-6744
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLMLP775103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist