Healthcare Provider Details

I. General information

NPI: 1316504616
Provider Name (Legal Business Name): SARA SHALASH LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2019
Last Update Date: 05/30/2025
Certification Date: 05/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 S LIMESTONE STE 304
LEXINGTON KY
40536-1827
US

IV. Provider business mailing address

496 SOUTHLAND DR
LEXINGTON KY
40503-1827
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-0303
  • Fax: 859-323-1200
Mailing address:
  • Phone: 859-288-2392
  • Fax: 859-721-2572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number255098
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: