MEDICARE: DR. SARAH BENNETT LAU PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	33520	MS
2	103TC0700X	Clinical Psychologist	P00001796	TN
3	103TC0700X	Clinical Psychologist	93-32P	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1801887591
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SARAH BENNETT LAU PH.D.

Provider Business Mailing Address
First Line	:	PO BOX 579
Second Line	:
City	:	OLIVE BRANCH
State	:	MS
Zip	:	38654-0579
Country	:	US
Telephone Number	:	662-895-1707
Fax Number	:	662-893-0388

Provider Business Practice Location Address
First Line	:	6978 OAK FOREST DR
Second Line	:
City	:	OLIVE BRANCH
State	:	MS
Zip	:	38654-1332
Country	:	US
Telephone Number	:	662-895-1707
Fax Number	:	662-893-0388

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/02/2005
Last Update Date	:	07/08/2007

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