MEDICARE: MRS. SARA MOORE KERAI LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	6401019434	MI
2	101YP2500X	Professional Counselor	0701009098	VA
3	101YP2500X	Professional Counselor	LC10855	MD
4	101YP2500X	Professional Counselor	PRC13868	DC

General Provider Information

NPI Number	:	1033428321
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SARA MOORE KERAI LPC

Provider Business Mailing Address
First Line	:	PO BOX 140074
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49514-0074
Country	:	US
Telephone Number	:	202-306-0448
Fax Number	:

Provider Business Practice Location Address
First Line	:	1568 MOUNT MERCY DR NW
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49504-4905
Country	:	US
Telephone Number	:	202-306-0448
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/04/2010
Last Update Date	:	02/08/2024

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