Provider Demographics
NPI:1063620177
Name:BREMER PARKS, SARAH ANN (MS, LCP)
Entity type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:ANN
Last Name:BREMER PARKS
Suffix:
Gender:F
Credentials:MS, LCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:337 SW ELMWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66606-1233
Mailing Address - Country:US
Mailing Address - Phone:785-817-9136
Mailing Address - Fax:
Practice Address - Street 1:3500 SW 6TH AVE
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66606-2806
Practice Address - Country:US
Practice Address - Phone:785-817-9136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLCP # 217101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS0007612108OtherAETNA
KS425981OtherSOUTHWESTERN BELL
KS0000373287OtherBLUE CROSS BLUE SHIELD KS