Basic Information
| Provider Information | |||||||||
| NPI: | 1962494161 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WILLOUGHBY | ||||||||
| FirstName: | SARAH | ||||||||
| MiddleName: | ANNETTE | ||||||||
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| Credential: | L.C.S.W. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 18320 CHASE ST | ||||||||
| Address2: | |||||||||
| City: | NORTHRIDGE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913253609 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8187399705 | ||||||||
| FaxNumber: | 8189889143 | ||||||||
| Practice Location | |||||||||
| Address1: | 1030 MCINTOSH CIR STE 1 | ||||||||
| Address2: | |||||||||
| City: | JOPLIN | ||||||||
| State: | MO | ||||||||
| PostalCode: | 648043690 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4173478750 | ||||||||
| FaxNumber: | 4173478788 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/16/2005 | ||||||||
| LastUpdateDate: | 06/10/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/10/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 005975 | MO | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | PSIX995 | 05 | CA | MEDICAID | 34736011 | 01 | MO | BLUE CROSS BLUE SHIELD ID | OTHER | 496014002 | 05 | MO | MEDICAID |