Provider Demographics
NPI:1063898039
Name:SPORLEDER, SARAH (LCPC, LMFT)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:SPORLEDER
Suffix:
Gender:F
Credentials:LCPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:716 S 20TH AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-6824
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:716 S 20TH AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-6824
Practice Address - Country:US
Practice Address - Phone:406-404-5223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-31
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTSWP-LCPC-LIC-4584101YP2500X
MTSWP-LMFT-LIC-4709106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist