Healthcare Provider Details

I. General information

NPI: 1598082307
Provider Name (Legal Business Name): SARA EBY MA, LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2010
Last Update Date: 10/30/2024
Certification Date: 10/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7401 METRO BLVD STE 250
EDINA MN
55439-3062
US

IV. Provider business mailing address

PO BOX 51
VICTORIA MN
55386-0051
US

V. Phone/Fax

Practice location:
  • Phone: 612-268-5858
  • Fax:
Mailing address:
  • Phone: 952-443-4600
  • Fax: 952-443-4604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1065
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1065
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: