Provider Demographics
NPI:1205497575
Name:SMITH, SARA DEANNE (LAC, LPCC)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:DEANNE
Last Name:SMITH
Suffix:
Gender:F
Credentials:LAC, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6620 W 84TH CIR APT 117
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80003-1150
Mailing Address - Country:US
Mailing Address - Phone:720-296-0102
Mailing Address - Fax:
Practice Address - Street 1:3400 LUTHERAN PKWY
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-6035
Practice Address - Country:US
Practice Address - Phone:303-467-4878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-26
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO261QM0850X, 324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health