Provider Demographics
NPI:1366057846
Name:MORENO, SARAH (PLPC)
Entity type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:
Last Name:MORENO
Suffix:
Gender:F
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1303 LINE AVE
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71101-4628
Mailing Address - Country:US
Mailing Address - Phone:183-425-3400
Mailing Address - Fax:183-425-3447
Practice Address - Street 1:1303 LINE AVE
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-4628
Practice Address - Country:US
Practice Address - Phone:183-425-3400
Practice Address - Fax:183-425-3447
Is Sole Proprietor?:No
Enumeration Date:2020-09-11
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
LAPLC8494101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No171M00000XOther Service ProvidersCase Manager/Care Coordinator