Provider Demographics
NPI:1184299224
Name:ROSS, SARA (LCP-MHSP)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:ROSS
Suffix:
Gender:F
Credentials:LCP-MHSP
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:
Other - Last Name:MISCHKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NCC
Mailing Address - Street 1:2701 HOLLY SPRING DR
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-6217
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:152 TIMBER CREEK DR STE 4
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-4237
Practice Address - Country:US
Practice Address - Phone:901-347-2141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-21
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5488101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health