Provider Demographics
NPI:1205261583
Name:MCKEOWN WHITE, SARA HELEN (LCPC)
Entity type:Individual
Prefix:MRS
First Name:SARA
Middle Name:HELEN
Last Name:MCKEOWN WHITE
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:MS
Other - First Name:SARA
Other - Middle Name:HELEN
Other - Last Name:MCKEOWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCPC
Mailing Address - Street 1:PO BOX 1450
Mailing Address - Street 2:
Mailing Address - City:DRIGGS
Mailing Address - State:ID
Mailing Address - Zip Code:83422-0010
Mailing Address - Country:US
Mailing Address - Phone:803-320-3420
Mailing Address - Fax:
Practice Address - Street 1:1300 ARROWHEAD PLAZA WAY
Practice Address - Street 2:
Practice Address - City:DRIGGS
Practice Address - State:ID
Practice Address - Zip Code:83422
Practice Address - Country:US
Practice Address - Phone:803-320-3420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-05
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-4927101YP2500X
IDLCPC-6331101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional