Provider Demographics
NPI:1336983436
Name:MEJAK, SARA JO SAMANTHA (LMHC)
Entity type:Individual
Prefix:
First Name:SARA JO
Middle Name:SAMANTHA
Last Name:MEJAK
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8570 KNOLL XING
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-3571
Mailing Address - Country:US
Mailing Address - Phone:701-789-8047
Mailing Address - Fax:
Practice Address - Street 1:8570 KNOLL XING
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-3571
Practice Address - Country:US
Practice Address - Phone:701-789-8047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-24
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39004923A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty