Provider Demographics
NPI:1285810010
Name:VETTER, SARA J (LPCC)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:J
Last Name:VETTER
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1148
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58702-1148
Mailing Address - Country:US
Mailing Address - Phone:701-837-6508
Mailing Address - Fax:701-858-1839
Practice Address - Street 1:1227 N 35TH ST
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-7722
Practice Address - Country:US
Practice Address - Phone:701-837-6508
Practice Address - Fax:701-858-1839
Is Sole Proprietor?:No
Enumeration Date:2008-01-10
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND3734197130101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND28568OtherBLUE CROSS BLUE SHIELD
ND26048015358501A005OtherTRICARE