Basic Information
| Provider Information | |||||||||
| NPI: | 1154508216 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ERIE | ||||||||
| FirstName: | SARA | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MS NCC LPCC LP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | LIEN | ||||||||
| OtherFirstName: | SARA | ||||||||
| OtherMiddleName: | A | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 40520 COUNTY HIGHWAY 34 | ||||||||
| Address2: | MENTAL HEALTH | ||||||||
| City: | OGEMA | ||||||||
| State: | MN | ||||||||
| PostalCode: | 565699612 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2189836325 | ||||||||
| FaxNumber: | 2189836336 | ||||||||
| Practice Location | |||||||||
| Address1: | 40520 COUNTY HIGHWAY 34 | ||||||||
| Address2: | MENTAL HEALTH | ||||||||
| City: | OGEMA | ||||||||
| State: | MN | ||||||||
| PostalCode: | 565699612 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2189836325 | ||||||||
| FaxNumber: | 2189836336 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/30/2008 | ||||||||
| LastUpdateDate: | 03/03/2016 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 00729 | MN | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.