Provider Demographics
NPI:1801540711
Name:WHITE, SARAH ANN (LPC)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:ANN
Last Name:WHITE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:SARAH
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMHC
Mailing Address - Street 1:4123 GRANADA DR
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628-1617
Mailing Address - Country:US
Mailing Address - Phone:150-836-0958
Mailing Address - Fax:
Practice Address - Street 1:100 N HOWARD ST STE R
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-0508
Practice Address - Country:US
Practice Address - Phone:512-630-8166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-09
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX88010101Y00000X, 101YP2500X
WALH61521819101YM0800X
WAMC61513555101YM0800X
ID10075101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID10075OtherLPC
TX993556682Medicaid
WA990705215Medicaid
WALMHC.LH61521819Medicaid
ID10075Medicaid
WAMHCA.MC.61513555Medicaid