Provider Demographics
NPI:1295055960
Name:CRAIG, SARA LYNN (LPC)
Entity type:Individual
Prefix:MRS
First Name:SARA
Middle Name:LYNN
Last Name:CRAIG
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 1:3 OAK TREE VLG STE 1
Mailing Address - Street 2:
Mailing Address - City:DONIPHAN
Mailing Address - State:MO
Mailing Address - Zip Code:63935-1907
Mailing Address - Country:US
Mailing Address - Phone:573-996-2194
Mailing Address - Fax:573-996-2191
Practice Address - Street 1:3 OAK TREE VLG STE 1
Practice Address - Street 2:
Practice Address - City:DONIPHAN
Practice Address - State:MO
Practice Address - Zip Code:63935-1907
Practice Address - Country:US
Practice Address - Phone:573-996-2194
Practice Address - Fax:573-996-2191
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-04
Last Update Date:2010-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO002180101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO002180Medicaid
MO498607712Medicaid