Provider Demographics
NPI:1770155335
Name:GITTINS, SARAH (LAC)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:GITTINS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59802-3911
Mailing Address - Country:US
Mailing Address - Phone:406-541-4673
Mailing Address - Fax:406-327-0042
Practice Address - Street 1:1120 CEDAR ST
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-3911
Practice Address - Country:US
Practice Address - Phone:406-541-4673
Practice Address - Fax:406-327-0042
Is Sole Proprietor?:No
Enumeration Date:2021-07-13
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LAC-LIC-48465101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)