Healthcare Provider Details

I. General information

NPI: 1427483783
Provider Name (Legal Business Name): SARAH LEANNE GANN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2013
Last Update Date: 09/17/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1108 N, WHEELER AVENUE
SALLISAW OK
74955
US

IV. Provider business mailing address

1130 JESS DRIVE
SALLISAW OK
74955
US

V. Phone/Fax

Practice location:
  • Phone: 918-775-5513
  • Fax: 918-775-5526
Mailing address:
  • Phone: 918-571-8710
  • Fax: 479-452-5047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number11023
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: