Provider Demographics
NPI:1952867400
Name:PALACIOS, SARAH CASEY (LCDC-I)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:CASEY
Last Name:PALACIOS
Suffix:
Gender:F
Credentials:LCDC-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6901 MEADOWBREEZE PKWY
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-2738
Mailing Address - Country:US
Mailing Address - Phone:361-442-5843
Mailing Address - Fax:
Practice Address - Street 1:5633 S STAPLES ST
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-4646
Practice Address - Country:US
Practice Address - Phone:361-814-2001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-20
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX44515101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)