Provider Demographics
NPI:1194853762
Name:MERSDORF-FOREMAN, SARAH M (LMSW)
Entity type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:M
Last Name:MERSDORF-FOREMAN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MRS
Other - First Name:SARAH
Other - Middle Name:
Other - Last Name:FOREMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMSW
Mailing Address - Street 1:PO BOX 2945
Mailing Address - Street 2:
Mailing Address - City:LIBERAL
Mailing Address - State:KS
Mailing Address - Zip Code:67905-2945
Mailing Address - Country:US
Mailing Address - Phone:620-624-8171
Mailing Address - Fax:620-624-0114
Practice Address - Street 1:333 W 15TH ST
Practice Address - Street 2:
Practice Address - City:LIBERAL
Practice Address - State:KS
Practice Address - Zip Code:67901-2455
Practice Address - Country:US
Practice Address - Phone:620-624-8171
Practice Address - Fax:620-624-0114
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS6031101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health