Provider Demographics
NPI:1932699014
Name:BURGESS, SARAH JEAN (LPCC)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:JEAN
Last Name:BURGESS
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1845 MAY VALLEY RD SW
Mailing Address - Street 2:
Mailing Address - City:NEW PHILADELPHIA
Mailing Address - State:OH
Mailing Address - Zip Code:44663-7948
Mailing Address - Country:US
Mailing Address - Phone:330-407-1959
Mailing Address - Fax:
Practice Address - Street 1:1845 MAY VALLEY RD SW
Practice Address - Street 2:
Practice Address - City:NEW PHILADELPHIA
Practice Address - State:OH
Practice Address - Zip Code:44663-7948
Practice Address - Country:US
Practice Address - Phone:330-407-1959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-15
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.2203014101YP2500X
OHLICDC.161971101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)