Healthcare Provider Details

I. General information

NPI: 1235680075
Provider Name (Legal Business Name): SARAH HURST-PELFREY LPC / LICDC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARAH HURST

II. Dates (important events)

Enumeration Date: 10/17/2016
Last Update Date: 01/15/2020
Certification Date: 01/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 PARK AVENUE WEST
MANSFIELD OH
44906-2641
US

IV. Provider business mailing address

680 PARK AVENUE WEST
MANSFIELD OH
44906-2641
US

V. Phone/Fax

Practice location:
  • Phone: 419-528-5993
  • Fax:
Mailing address:
  • Phone: 419-528-5993
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLICDC.161412
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC.1801127
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: