Healthcare Provider Details

I. General information

NPI: 1164156642
Provider Name (Legal Business Name): SARAH COBBLE LPATA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2022
Last Update Date: 07/12/2022
Certification Date: 07/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

541 BUTTERMILK PIKE STE 200
CRESCENT SPRINGS KY
41017-1696
US

IV. Provider business mailing address

541 BUTTERMILK PIKE STE 200
CRESCENT SPRINGS KY
41017-1696
US

V. Phone/Fax

Practice location:
  • Phone: 859-869-2023
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number278367
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number278367
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: