Provider Demographics
NPI:1265981260
Name:SHIDELER, SARA (LCSW)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:SHIDELER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 W 34TH ST STE 600-282
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77018-6256
Mailing Address - Country:US
Mailing Address - Phone:713-322-4588
Mailing Address - Fax:
Practice Address - Street 1:1502 SAWYER ST STE 139
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77007
Practice Address - Country:US
Practice Address - Phone:713-322-4588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-02
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW.099243731041C0700X
TX645051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical