Healthcare Provider Details

I. General information

NPI: 1871190389
Provider Name (Legal Business Name): KELLY JEAN SACHAU LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2020
Last Update Date: 01/18/2025
Certification Date: 01/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1119 4TH ST STE 220-A
SIOUX CITY IA
51101-1900
US

IV. Provider business mailing address

1119 4TH ST STE 220-A
SIOUX CITY IA
51101-1900
US

V. Phone/Fax

Practice location:
  • Phone: 712-847-2226
  • Fax: 712-268-6786
Mailing address:
  • Phone: 712-847-2226
  • Fax: 712-268-6786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number106139
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number106139
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: