Provider Demographics
NPI:1750684940
Name:IVERSON, SARA NICOLE (MA LMHC LPC)
Entity type:Individual
Prefix:MRS
First Name:SARA
Middle Name:NICOLE
Last Name:IVERSON
Suffix:
Gender:F
Credentials:MA LMHC LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 E CHEROKEE ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-2610
Mailing Address - Country:US
Mailing Address - Phone:319-594-4564
Mailing Address - Fax:
Practice Address - Street 1:3259 E SUNSHINE ST STE L
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-2143
Practice Address - Country:US
Practice Address - Phone:319-594-4564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-10
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024014163101YM0800X
IA001288101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health