Provider Demographics
NPI:1821345794
Name:BRENNAN, SARA (MED, LCDC)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:BRENNAN
Suffix:
Gender:F
Credentials:MED, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12948 PIANO MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:CONIFER
Mailing Address - State:CO
Mailing Address - Zip Code:80433-5014
Mailing Address - Country:US
Mailing Address - Phone:361-589-1027
Mailing Address - Fax:800-854-6952
Practice Address - Street 1:3833 S STAPLES ST STE N202
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-5219
Practice Address - Country:US
Practice Address - Phone:361-589-1027
Practice Address - Fax:800-854-6952
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-10
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11792101YP2500X, 101YA0400X
CO0017019101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional