Provider Demographics
NPI:1942281951
Name:SARNO, ALBERT JAMES JR (PHD, LPC)
Entity Type:Individual
Prefix:
First Name:ALBERT
Middle Name:JAMES
Last Name:SARNO
Suffix:JR
Gender:M
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:AL
Other - Middle Name:
Other - Last Name:SARNO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD, LPC, BCPC
Mailing Address - Street 1:1300 E BRADFORD PKWY
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-4264
Mailing Address - Country:US
Mailing Address - Phone:417-761-5000
Mailing Address - Fax:417-761-5065
Practice Address - Street 1:1801 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SEDALIA
Practice Address - State:MO
Practice Address - Zip Code:65301-3636
Practice Address - Country:US
Practice Address - Phone:660-827-2494
Practice Address - Fax:660-827-1606
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-08
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO001067101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO8616OtherGATEWAY EDI
MO191011OtherBCBS MO
MO493474910Medicaid
MO493474910Medicaid