Provider Demographics
NPI:1700486123
Name:STAUDY, SARAH MAE
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:MAE
Last Name:STAUDY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 MOUNTAIN RANCH RD STE 105
Mailing Address - Street 2:
Mailing Address - City:SAN ANDREAS
Mailing Address - State:CA
Mailing Address - Zip Code:95249-8902
Mailing Address - Country:US
Mailing Address - Phone:209-754-6525
Mailing Address - Fax:
Practice Address - Street 1:704 MOUNTAIN RANCH RD STE 105
Practice Address - Street 2:
Practice Address - City:SAN ANDREAS
Practice Address - State:CA
Practice Address - Zip Code:95249-8902
Practice Address - Country:US
Practice Address - Phone:209-754-6525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-26
Last Update Date:2025-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT144409106H00000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health