Sarah L Boulac, MA
Individual provider Active NPI Mental Health Counselor · Lafayette, IN
NPI 1689804114 · NPPES record last updated May 10, 2019
Key facts
- NPI
- 1689804114
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Mental Health Counselor 101YM0800X
- License
- 39003518A (IN)
- Practice address
- 615 N 18TH St Ste 101
Lafayette, IN 47904-3413 - Phone
- (765) 423-5361
- Fax
- (765) 447-8411
- NPI assigned
- Jul 17, 2009
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 39003518A | IN | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Willowstone Family Services | Mental Health | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 39003518A | IN | Yes |
Addresses
Primary practice location
615 N 18TH St Ste 101
Lafayette, IN 47904-3413
Mailing address
615 N 18TH St Ste 101
Lafayette, IN 47904-3413
Phone (765) 423-5361
Other providers in Lafayette, IN
- David Heine Bos
- Roger Bosley
- Emily G Bosso
- Anna Bostian
- Mallory Bottorff
- Claire Bour
- Jarred Bowden
- Corbin Bower
- Kelsey Bower
- David Alan Bowman
All providers in Lafayette, IN · Mental Health Counselor in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 10, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.