Provider Demographics
NPI:1770329666
Name:PERSHA, SARA (LPC)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:PERSHA
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 1:234 HIGH VIEW LN
Mailing Address - Street 2:
Mailing Address - City:OCONOMOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:53066-4260
Mailing Address - Country:US
Mailing Address - Phone:262-751-6429
Mailing Address - Fax:
Practice Address - Street 1:234 HIGH VIEW LN
Practice Address - Street 2:
Practice Address - City:OCONOMOWOC
Practice Address - State:WI
Practice Address - Zip Code:53066-4260
Practice Address - Country:US
Practice Address - Phone:262-751-6429
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-01
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10216-125101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health