Healthcare Provider Details

I. General information

NPI: 1972972255
Provider Name (Legal Business Name): SARAH MARTIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2015
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 WHISPERING MEADOWS RD
BROUSSARD LA
70518-7931
US

IV. Provider business mailing address

113 FLAGG PL STE 6B
LAFAYETTE LA
70508-7025
US

V. Phone/Fax

Practice location:
  • Phone: 504-442-1163
  • Fax: 504-442-1163
Mailing address:
  • Phone: 504-442-1163
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number5970
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: