Provider Demographics
NPI:1902925712
Name:BIGELOW, SARA ANNE (LCPC)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:ANNE
Last Name:BIGELOW
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:ANNE
Other - Last Name:AGUILAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCPC
Mailing Address - Street 1:850 E CENTER ST STE B
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-5737
Mailing Address - Country:US
Mailing Address - Phone:208-251-0226
Mailing Address - Fax:208-251-3282
Practice Address - Street 1:850 E CENTER ST STE B
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-5737
Practice Address - Country:US
Practice Address - Phone:208-251-0226
Practice Address - Fax:208-251-3282
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC-3931101Y00000X
IDLPC-3425101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor