Individual
SARA PROVO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPCC
Contact information
Practice address
1772 STIEGER LAKE LN STE 220, VICTORIA, MN 55386-7723
(952) 443-4600
(952) 443-4604
Mailing address
PO BOX 51, VICTORIA, MN 55386-0051
(952) 443-4600
(952) 443-4604
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
2765
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LPCC2765
MN BOARD OF BH
MN
Enumeration date
03/17/2021
Last updated
04/06/2021
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