Provider Demographics
NPI:1780166975
Name:FARRELL, SARA (LPC)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:FARRELL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:
Other - Last Name:BUCKHANNON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:745 CRAIG RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-7160
Mailing Address - Country:US
Mailing Address - Phone:324-730-0472
Mailing Address - Fax:
Practice Address - Street 1:745 CRAIG RD
Practice Address - Street 2:
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141-7160
Practice Address - Country:US
Practice Address - Phone:314-730-0472
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-04
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013018121103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty