=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053752048
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SARAH R TOMCALA MA, LPC, CADC, LMHC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/08/2013
-----------------------------------------------------
Last Update Date | 08/09/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1175 JASON LEE DR
-----------------------------------------------------
City | OWOSSO
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48867-9029
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-370-7310
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1175 JASON LEE DR
-----------------------------------------------------
City | OWOSSO
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48867-9029
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-370-7310
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 6401014789
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number | 6401014789
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------