Provider Demographics
NPI:1740445345
Name:MEARS-IVY, SARAH LEA (LPC)
Entity type:Individual
Prefix:MS
First Name:SARAH
Middle Name:LEA
Last Name:MEARS-IVY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7413 OAK AVE
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-9058
Mailing Address - Country:US
Mailing Address - Phone:580-660-5931
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 3373
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73083-3373
Practice Address - Country:US
Practice Address - Phone:405-440-3034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-23
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK11451101YP2500X
OK251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional