Basic Information
| Provider Information | |||||||||
| NPI: | 1538511209 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TITTLE | ||||||||
| FirstName: | SARA | ||||||||
| MiddleName: | ELISABETH | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 614 | ||||||||
| Address2: | |||||||||
| City: | HOPKINSVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 422410614 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2708862205 | ||||||||
| FaxNumber: | 2708860392 | ||||||||
| Practice Location | |||||||||
| Address1: | 1350 US HIGHWAY 62 W | ||||||||
| Address2: | |||||||||
| City: | PRINCETON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 424456106 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2703652008 | ||||||||
| FaxNumber: | 2703652009 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2016 | ||||||||
| LastUpdateDate: | 08/16/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 252038 | KY | N | Behavioral Health & Social Service Providers | Social Worker | 1041C0700X | 254361 | KY | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.