Provider Demographics
NPI:1134980196
Name:RUNYON, SARAH (CPC-INTERN)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:RUNYON
Suffix:
Gender:F
Credentials:CPC-INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10655 PARK RUN DR STE 210
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89144-4590
Mailing Address - Country:US
Mailing Address - Phone:702-805-5848
Mailing Address - Fax:
Practice Address - Street 1:10655 PARK RUN DR STE 210
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89144-4590
Practice Address - Country:US
Practice Address - Phone:702-805-5848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-17
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVC15149101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional