Provider Demographics
NPI:1316503105
Name:SARAH PETERSON LCSW LLC
Entity type:Organization
Organization Name:SARAH PETERSON LCSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:541-771-8769
Mailing Address - Street 1:63480 PHOENIX WAY
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-8009
Mailing Address - Country:US
Mailing Address - Phone:541-480-1237
Mailing Address - Fax:541-623-2585
Practice Address - Street 1:147 SW SHEVLIN HIXON DR STE 104
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-3185
Practice Address - Country:US
Practice Address - Phone:541-480-1237
Practice Address - Fax:541-623-2585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-16
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty