MEDICARE: MS. SARA PETERSON M.S., LCPC

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
2	101YM0800X	Mental Health Counselor	CP1274	NV

General Provider Information

NPI Number	:	1164876132
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SARA PETERSON M.S., LCPC

Provider Business Mailing Address
First Line	:	8461 W. FARM RD. STE.120
Second Line	:	#423
City	:	LAS VEGAS
State	:	NV
Zip	:	89131-8306
Country	:	US
Telephone Number	:	702-970-4158
Fax Number	:	855-940-4887

Provider Business Practice Location Address
First Line	:	7495 W AZURE DR STE 204
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89130-4423
Country	:	US
Telephone Number	:	702-970-4158
Fax Number	:	855-940-4887

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

Provider Enumeration Date	:	04/15/2016
Last Update Date	:	05/16/2025

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