Sara Heatwole Bojorquez, LPCC-S
Individual provider Active NPI Mental Health Counselor · Archbold, OH
NPI 1790077451 · NPPES record last updated Apr 3, 2023
Key facts
- NPI
- 1790077451
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Mental Health Counselor 101YM0800X
- License
- E1600088 (OH)
- Practice address
- 22251 State Route 2
Archbold, OH 43502-9452 - Phone
- (419) 445-1552
- NPI assigned
- May 12, 2011
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OH
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250327003820 | OH | Practitioner - Clinical Social Worker | 8426571696 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| E1600088 | OH | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Empowered for Excellence, Empowering Youth, LLC | Current |
Accepting new patients | |
| Empowered for Excellence Behavioral Health Ohio | Current |
Accepting new patients | |
| Shalom Ministries | Past |
Accepting new patients |
Locations
3170 W Central Ave
Toledo, OH 43606
Phone (567) 803-9706
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | E1600088 | OH | Yes |
Addresses
Primary practice location
22251 State Route 2
Archbold, OH 43502-9452
Mailing address
25925 County Rd E
Archbold, OH 43502-9810
Phone (540) 383-1047
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| E1600088 | Other | OH | STATE OF OHIO COUNSELOR, SOCIAL WORKER, MARRIAGE AND FAMILY THERAPIST BOARD |
Other names
- Sara Marie Gorr
Other providers in Archbold, OH
- Amy Jo Bauerle
- Heidi M Bell
- Amy Bennett
- Jennifer Renee Bergstedt
- Andrea Marie Bohls
- Mary Margaret Bowling
- Randy Eugene Box
- Kelly Breen
- Johnathan Britsch
- Michael J Britsch
All providers in Archbold, OH · Mental Health Counselor in Ohio
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 3, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.