Provider Demographics
NPI:1295479475
Name:ELUSHIK, SARA KATHRYN (LCSW)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:KATHRYN
Last Name:ELUSHIK
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 1:145 MILL TOWN LOOP STE B
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-5144
Mailing Address - Country:US
Mailing Address - Phone:406-580-9857
Mailing Address - Fax:
Practice Address - Street 1:145 MILL TOWN LOOP STE B
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-5144
Practice Address - Country:US
Practice Address - Phone:406-580-9857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-25
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-SWLC-LIC-430351041C0700X
MTBBH-LCSW-LIC-622341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical