MEDICARE: SARA MAIRS LP

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	103TC1900X	Counseling Psychologist	LP5277	MN

General Provider Information

NPI Number	:	1861125296
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARA MAIRS LP

Provider Business Mailing Address
First Line	:	1649 RIDGEWOOD LN S
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55113-5625
Country	:	US
Telephone Number	:	651-230-3770
Fax Number	:

Provider Business Practice Location Address
First Line	:	475 CLEVELAND AVE N STE 301
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55104-5053
Country	:	US
Telephone Number	:	651-230-3770
Fax Number	:

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

Provider Enumeration Date	:	07/04/2022
Last Update Date	:	07/04/2022

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