Healthcare Provider Details

I. General information

NPI: 1639633100
Provider Name (Legal Business Name): SARAH HARTUNG LPC, RDT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2019
Last Update Date: 11/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1034 S MILL AVE
TEMPE AZ
85281-5606
US

IV. Provider business mailing address

6030 WESTMINSTER PL
SAINT LOUIS MO
63112-1412
US

V. Phone/Fax

Practice location:
  • Phone: 623-282-4446
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2015002773
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC-18532
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: