Provider Demographics
NPI:1952657744
Name:SCOTT, SARA J (LMHC, NCC)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:J
Last Name:SCOTT
Suffix:
Gender:F
Credentials:LMHC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52601-5426
Mailing Address - Country:US
Mailing Address - Phone:319-209-2084
Mailing Address - Fax:319-209-2086
Practice Address - Street 1:506 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52601-5426
Practice Address - Country:US
Practice Address - Phone:319-209-2084
Practice Address - Fax:319-209-2086
Is Sole Proprietor?:No
Enumeration Date:2012-07-30
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
IA077529101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1952657744Medicaid