Provider Demographics
NPI:1104416742
Name:LIBERTY, SARAH ELIZABETH (BCBA, LBA, MA)
Entity type:Individual
Prefix:MS
First Name:SARAH
Middle Name:ELIZABETH
Last Name:LIBERTY
Suffix:
Gender:F
Credentials:BCBA, LBA, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:626 DIANA DR
Mailing Address - Street 2:
Mailing Address - City:CONVERSE
Mailing Address - State:TX
Mailing Address - Zip Code:78109-1130
Mailing Address - Country:US
Mailing Address - Phone:512-466-3883
Mailing Address - Fax:
Practice Address - Street 1:626 DIANA DR
Practice Address - Street 2:
Practice Address - City:CONVERSE
Practice Address - State:TX
Practice Address - Zip Code:78109-1130
Practice Address - Country:US
Practice Address - Phone:512-466-3883
Practice Address - Fax:866-936-4614
Is Sole Proprietor?:No
Enumeration Date:2021-01-18
Last Update Date:2024-05-16
Deactivation Date:2024-04-15
Deactivation Code:
Reactivation Date:2024-05-13
Provider Licenses
StateLicense IDTaxonomies
TX1-24-72387103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst