Provider Demographics
NPI:1023299971
Name:MARY K. SARGIS
Entity type:Organization
Organization Name:MARY K. SARGIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:K
Authorized Official - Last Name:SARGIS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:502-222-1945
Mailing Address - Street 1:704 W JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:KY
Mailing Address - Zip Code:40031-1044
Mailing Address - Country:US
Mailing Address - Phone:502-222-1945
Mailing Address - Fax:502-222-4301
Practice Address - Street 1:704 W JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:KY
Practice Address - Zip Code:40031-1044
Practice Address - Country:US
Practice Address - Phone:502-222-1945
Practice Address - Fax:502-222-4301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-20
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1169251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0091501Medicare PIN
KY9915Medicare PIN