MEDICARE: DR. LORY CRYSTAL SANDOVAL D.P.C, L.P.C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	68787	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	68787	OTHER	TX	LPC LICENSING BOARD OF TEXAS

General Provider Information

NPI Number	:	1568898443
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LORY CRYSTAL SANDOVAL D.P.C, L.P.C

Provider Business Mailing Address
First Line	:	1348 MARK PL
Second Line	:
City	:	MISSION
State	:	TX
Zip	:	78572-5919
Country	:	US
Telephone Number	:	956-222-9942
Fax Number	:

Provider Business Practice Location Address
First Line	:	1348 MARK PL
Second Line	:
City	:	MISSION
State	:	TX
Zip	:	78572-5919
Country	:	US
Telephone Number	:	956-222-9942
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/23/2013
Last Update Date	:	03/30/2025

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