Healthcare Provider Details

I. General information

NPI: 1134455512
Provider Name (Legal Business Name): SARAH J HERNDON LPC-MHSP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SARAH J WILLIS LPC-MHSP

II. Dates (important events)

Enumeration Date: 10/20/2009
Last Update Date: 05/22/2024
Certification Date: 05/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5819 WINDING LN STE 105
HIXSON TN
37343-4067
US

IV. Provider business mailing address

5819 WINDING LN STE 105
HIXSON TN
37343-4067
US

V. Phone/Fax

Practice location:
  • Phone: 423-402-0126
  • Fax: 866-858-7831
Mailing address:
  • Phone: 423-402-0126
  • Fax: 866-858-7831

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC0000002530
License Number StateTN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1520383
Identifier TypeMEDICAID
Identifier StateTN
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: