Provider Demographics
NPI:1568839603
Name:BALES, SARA ANN (LCSW/CCDPD)
Entity type:Individual
Prefix:MRS
First Name:SARA
Middle Name:ANN
Last Name:BALES
Suffix:
Gender:F
Credentials:LCSW/CCDPD
Other - Prefix:MISS
Other - First Name:SARA
Other - Middle Name:ANN
Other - Last Name:SIMON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1208 CYPRESS SPRINGS TRL
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75072-8980
Mailing Address - Country:US
Mailing Address - Phone:181-687-6321
Mailing Address - Fax:
Practice Address - Street 1:1208 CYPRESS SPRINGS TRL
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75072-8980
Practice Address - Country:US
Practice Address - Phone:816-876-3216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-24
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20150295281041C0700X
TX1054271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical