Provider Demographics
NPI:1316733678
Name:RICHISON, SARA
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:RICHISON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 N RUSSELL ST
Mailing Address - Street 2:
Mailing Address - City:PAMPA
Mailing Address - State:TX
Mailing Address - Zip Code:79065-4317
Mailing Address - Country:US
Mailing Address - Phone:806-662-2616
Mailing Address - Fax:
Practice Address - Street 1:120 W KINGSMILL AVE STE 405
Practice Address - Street 2:
Practice Address - City:PAMPA
Practice Address - State:TX
Practice Address - Zip Code:79065-6445
Practice Address - Country:US
Practice Address - Phone:806-440-2728
Practice Address - Fax:806-395-3675
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-15
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX92163101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor