Healthcare Provider Details

I. General information

NPI: 1760885107
Provider Name (Legal Business Name): SARA CZUBAK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2014
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4660 S HAGADORN RD SUITE 280A
EAST LANSING MI
48823-5376
US

IV. Provider business mailing address

PO BOX 10
MASON MI
48854-0010
US

V. Phone/Fax

Practice location:
  • Phone: 517-927-6595
  • Fax:
Mailing address:
  • Phone: 517-927-6595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6361004348
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6361004348
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: