Provider Demographics
NPI:1386766236
Name:SAWYER, ROBERTA (LMFT)
Entity type:Individual
Prefix:MS
First Name:ROBERTA
Middle Name:
Last Name:SAWYER
Suffix:
Gender:F
Credentials:LMFT
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 4919
Mailing Address - Street 2:
Mailing Address - City:KETCHUM
Mailing Address - State:ID
Mailing Address - Zip Code:83340-4919
Mailing Address - Country:US
Mailing Address - Phone:208-726-3608
Mailing Address - Fax:208-726-3608
Practice Address - Street 1:220 RIVERS ST.
Practice Address - Street 2:SUITE 202
Practice Address - City:KETCHUM
Practice Address - State:ID
Practice Address - Zip Code:83340
Practice Address - Country:US
Practice Address - Phone:208-726-3608
Practice Address - Fax:208-726-3608
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMFT-30101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health