Healthcare Provider Details

I. General information

NPI: 1194005504
Provider Name (Legal Business Name): SARAH THOMAS M.A., LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2011
Last Update Date: 08/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8603 E EASTRIDGE RD STE A
PRESCOTT VALLEY AZ
86314-8562
US

IV. Provider business mailing address

8603 E EASTRIDGE RD STE A
PRESCOTT VALLEY AZ
86314-8562
US

V. Phone/Fax

Practice location:
  • Phone: 928-777-3280
  • Fax: 928-717-1660
Mailing address:
  • Phone: 928-777-3280
  • Fax: 928-717-1660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLAC-13471
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: