Provider Demographics
NPI:1710421854
Name:BRANSCUM, SARA (MA)
Entity type:Individual
Prefix:MS
First Name:SARA
Middle Name:
Last Name:BRANSCUM
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1726 E GAYLON DR
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-2719
Mailing Address - Country:US
Mailing Address - Phone:602-810-5662
Mailing Address - Fax:
Practice Address - Street 1:4500 N 32ND ST STE 201J
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-0003
Practice Address - Country:US
Practice Address - Phone:602-922-6456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-08
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-22091101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health