Provider Demographics
NPI:1528474251
Name:KNUTSON, SARA GRACE (MA, LPC)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:GRACE
Last Name:KNUTSON
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1807 SYLVAN LN
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-6760
Mailing Address - Country:US
Mailing Address - Phone:989-708-9564
Mailing Address - Fax:
Practice Address - Street 1:240 W MAIN ST STE 2600
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-5191
Practice Address - Country:US
Practice Address - Phone:989-906-0433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-02
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401016122101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional