Provider Demographics
NPI:1336711084
Name:LYDEN, SARA MARIE (LLMSW)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:MARIE
Last Name:LYDEN
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9580 FROST RD
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48609-9310
Mailing Address - Country:US
Mailing Address - Phone:989-928-0361
Mailing Address - Fax:
Practice Address - Street 1:9580 FROST RD
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48609-9310
Practice Address - Country:US
Practice Address - Phone:989-928-0361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-13
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801104472101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health