Provider Demographics
NPI:1154885028
Name:SARA J. W. BIEBL, PH.D., LICENSED PSYCHOLOGIST, PLLC
Entity type:Organization
Organization Name:SARA J. W. BIEBL, PH.D., LICENSED PSYCHOLOGIST, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:J W
Authorized Official - Last Name:BIEBL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:701-306-5645
Mailing Address - Street 1:500 UTAH AVE S
Mailing Address - Street 2:
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55426-1330
Mailing Address - Country:US
Mailing Address - Phone:701-306-5645
Mailing Address - Fax:
Practice Address - Street 1:7900 XERXES AVE S STE 1125
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55431-1112
Practice Address - Country:US
Practice Address - Phone:952-854-2622
Practice Address - Fax:952-854-3293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-24
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty