Provider Demographics
NPI:1184156267
Name:PRUST, SARAH
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:PRUST
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6827 S IVY ST
Mailing Address - Street 2:#3-202
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-6272
Mailing Address - Country:US
Mailing Address - Phone:719-964-7760
Mailing Address - Fax:
Practice Address - Street 1:6827 S IVY ST
Practice Address - Street 2:#3-202
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-6272
Practice Address - Country:US
Practice Address - Phone:719-964-7760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-29
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)