Healthcare Provider Details

I. General information

NPI: 1053848135
Provider Name (Legal Business Name): SARA BUPP LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2017
Last Update Date: 05/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 S GEORGE ST STE 401
YORK PA
17401-1400
US

IV. Provider business mailing address

680 AMERICAN AVE STE 302
KING OF PRUSSIA PA
19406-4023
US

V. Phone/Fax

Practice location:
  • Phone: 610-644-6464
  • Fax: 610-981-6078
Mailing address:
  • Phone: 610-644-6464
  • Fax: 610-981-6078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC009582
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: