Sara Provo, LPCC | |
1772 Stieger Lake Ln Ste 220, Victoria, MN 55386-7723 | |
(952) 443-4600 | |
(952) 443-4604 |
Full Name | Sara Provo |
---|---|
Gender | Female |
Speciality | Counselor - Mental Health |
Location | 1772 Stieger Lake Ln Ste 220, Victoria, Minnesota |
Accepts Medicare Assignments | Does not participate in Medicare Program. She may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1912582354 | NPI | - | NPPES |
LPCC2765 | Other | MN | MN BOARD OF BH |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
101YM0800X | Counselor - Mental Health | 2765 (Minnesota) | Primary |
Mailing Address | Practice Location Address |
---|---|
Sara Provo, LPCC Po Box 51, Victoria, MN 55386-0051 Ph: (952) 443-4600 | Sara Provo, LPCC 1772 Stieger Lake Ln Ste 220, Victoria, MN 55386-7723 Ph: (952) 443-4600 |
Christine Herzog, LPCC Counselor Medicare: Medicare Enrolled Practice Location: 1772 Stieger Lake Ln Ste 220, Victoria, MN 55386 Phone: 952-443-4600 | |
Tris Rene Casciaro, MA LPC Counselor Medicare: Not Enrolled in Medicare Practice Location: 1699 Stieger Lake Ln Apt 210, Victoria, MN 55386 Phone: 612-715-3011 |