1285934711 NPI number — MS. SARA ANNE CANTU LPC

Table of content: MS. SARA ANNE CANTU LPC (NPI 1285934711)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285934711 NPI number — MS. SARA ANNE CANTU LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CANTU
Provider First Name:
SARA
Provider Middle Name:
ANNE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285934711
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/29/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8745 GARY BURNS DR STE 160
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRISCO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75034-2551
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-534-3102
Provider Business Mailing Address Fax Number:
469-574-5538

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7000 PARKWOOD BLVD STE D100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRISCO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75034-7453
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-534-3102
Provider Business Practice Location Address Fax Number:
469-574-5538
Provider Enumeration Date:
11/01/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  64649 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)