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General NPI Number Information
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NPI Number | 1164876132
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Entity Type | Individual
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Provider Name | SARA PETERSON M.S., LCPC
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Gender | Female
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Dates
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Enumeration Date | 04/15/2016
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Last Update Date | 05/16/2025
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Provider Practice Location Address
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Address Line | 7495 W AZURE DR STE 204
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City | LAS VEGAS
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State | NV
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Zip | 89130-4423
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Country | US
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Telephone | 702-970-4158
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Fax | 855-940-4887
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Provider Business Mailing Address
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Address Line | 8461 W. FARM RD. STE.120 #423
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City | LAS VEGAS
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State | NV
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Zip | 89131-8306
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Country | US
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Telephone | 702-970-4158
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Fax | 855-940-4887
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | CP1274
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License Number State | NV
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