Healthcare Provider Details

I. General information

NPI: 1326407032
Provider Name (Legal Business Name): SARA LISTAR-GUEST LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2016
Last Update Date: 02/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4420 S 32ND ST
PHOENIX AZ
85040-2804
US

IV. Provider business mailing address

3450 N 3RD ST
PHOENIX AZ
85012-2331
US

V. Phone/Fax

Practice location:
  • Phone: 602-268-8748
  • Fax: 602-253-1557
Mailing address:
  • Phone: 602-257-9339
  • Fax: 602-265-8533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number15147
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: