Provider Demographics
NPI:1447976212
Name:VETCH, SARA JEAN (LPC SUPERVISEE)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:JEAN
Last Name:VETCH
Suffix:
Gender:F
Credentials:LPC SUPERVISEE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:523 N DULUTH AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57104-2714
Mailing Address - Country:US
Mailing Address - Phone:605-988-3775
Mailing Address - Fax:
Practice Address - Street 1:523 N DULUTH AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57104-2714
Practice Address - Country:US
Practice Address - Phone:605-988-3775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-13
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD20835101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional