Provider Demographics
NPI:1053623439
Name:THORNTON, SARA ELIABETH (LCSW)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:ELIABETH
Last Name:THORNTON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:
Other - Last Name:THORNTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 150
Mailing Address - Street 2:120 E AVE SUITE 6
Mailing Address - City:WINFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63389-0150
Mailing Address - Country:US
Mailing Address - Phone:314-497-9657
Mailing Address - Fax:
Practice Address - Street 1:120 EAST AVE
Practice Address - Street 2:SUITE 6
Practice Address - City:WINFIELD
Practice Address - State:MO
Practice Address - Zip Code:63389-3440
Practice Address - Country:US
Practice Address - Phone:314-497-9657
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-13
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20090322681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical