Provider Demographics
NPI:1992079164
Name:TIERNEY, SARAH ANN (LPC)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:ANN
Last Name:TIERNEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 N WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT PULASKI
Mailing Address - State:IL
Mailing Address - Zip Code:62548-1146
Mailing Address - Country:US
Mailing Address - Phone:217-737-2055
Mailing Address - Fax:
Practice Address - Street 1:115 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:MOUNT PULASKI
Practice Address - State:IL
Practice Address - Zip Code:62548-1146
Practice Address - Country:US
Practice Address - Phone:217-737-2055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-05
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.007734101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional