Provider Demographics
NPI:1932769403
Name:TABOR-SOUR, SARITA M (LMFT)
Entity type:Individual
Prefix:
First Name:SARITA
Middle Name:M
Last Name:TABOR-SOUR
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:SARITA
Other - Middle Name:M
Other - Last Name:TABOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7300 147TH ST W STE 215
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124-7580
Mailing Address - Country:US
Mailing Address - Phone:651-294-6112
Mailing Address - Fax:
Practice Address - Street 1:7300 147TH ST W STE 215
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55124-7580
Practice Address - Country:US
Practice Address - Phone:651-294-6112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-17
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3488106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist