Provider Demographics
NPI:1861125296
Name:MAIRS, SARA (LP)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:MAIRS
Suffix:
Gender:F
Credentials:LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1649 RIDGEWOOD LN S
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55113-5625
Mailing Address - Country:US
Mailing Address - Phone:651-230-3770
Mailing Address - Fax:
Practice Address - Street 1:475 CLEVELAND AVE N STE 301
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-5053
Practice Address - Country:US
Practice Address - Phone:651-230-3770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-04
Last Update Date:2022-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP5277103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling