Basic Information
Provider Information
NPI: 1689979403
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: JONES
FirstName: SARAH
MiddleName: R.
NamePrefix: MRS.
NameSuffix:  
Credential: LCPC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3923 MERCY DR
Address2: SUITE F
City: MCHENRY
State: IL
PostalCode: 600503173
CountryCode: US
TelephoneNumber: 8153445061
FaxNumber: 8153445072
Practice Location
Address1: 3923 MERCY DR
Address2: SUITE F
City: MCHENRY
State: IL
PostalCode: 600503173
CountryCode: US
TelephoneNumber: 8153445061
FaxNumber: 8153445072
Other Information
ProviderEnumerationDate: 01/26/2011
LastUpdateDate: 01/26/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101Y00000X180007716ILY Behavioral Health & Social Service ProvidersCounselor 

No ID Information.


Home