Provider Demographics
NPI:1861937948
Name:BICKERSTAFF, SARA (LMHC)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:BICKERSTAFF
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2244 132ND AVE SE APT B105
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-5324
Mailing Address - Country:US
Mailing Address - Phone:206-659-9530
Mailing Address - Fax:
Practice Address - Street 1:16771 NE 80TH ST
Practice Address - Street 2:SUITE 108
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-3959
Practice Address - Country:US
Practice Address - Phone:206-659-9530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-29
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60289638101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health