Provider Demographics
NPI:1427483783
Name:GANN, SARAH LEANNE (LPC)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:LEANNE
Last Name:GANN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 JESS DRIVE
Mailing Address - Street 2:
Mailing Address - City:SALLISAW
Mailing Address - State:OK
Mailing Address - Zip Code:74955
Mailing Address - Country:US
Mailing Address - Phone:918-571-8710
Mailing Address - Fax:479-452-5047
Practice Address - Street 1:1108 N, WHEELER AVENUE
Practice Address - Street 2:
Practice Address - City:SALLISAW
Practice Address - State:OK
Practice Address - Zip Code:74955
Practice Address - Country:US
Practice Address - Phone:918-775-5513
Practice Address - Fax:918-775-5526
Is Sole Proprietor?:No
Enumeration Date:2013-09-05
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK11023101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200766110Medicaid