1760940027 NPI number — MRS. SARAH ANN PERRAULT LCPC, LAC

Table of content: MRS. SARAH ANN PERRAULT LCPC, LAC (NPI 1760940027)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760940027 NPI number — MRS. SARAH ANN PERRAULT LCPC, LAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PERRAULT
Provider First Name:
SARAH
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCPC, LAC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MASON
Provider Other First Name:
SARAH
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1760940027
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/02/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 362
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SIDNEY
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59270-0362
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-230-1397
Provider Business Mailing Address Fax Number:
406-433-3586

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1405 4TH ST SW
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
SIDNEY
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59270
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-643-4095
Provider Business Practice Location Address Fax Number:
406-433-3586
Provider Enumeration Date:
03/06/2019

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: 101YA0400X , with the licence number:  BBH-LAC-LIC-38100 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: BBH-PCLC-LIC-31487 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YA0400X , with the licence number: BBH-ACLC-LIC-30295 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: BBH-LCPC-LIC-44272 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 100001540 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".




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