Healthcare Provider Details

I. General information

NPI: 1982944609
Provider Name (Legal Business Name): DEBRA MARIE SANDGREN LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DEBBIE MARIE SANDGREN LMFT

II. Dates (important events)

Enumeration Date: 02/15/2013
Last Update Date: 03/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 E 3RD AVE STE B
ESCONDIDO CA
92025-4252
US

IV. Provider business mailing address

30271 SILVER RIDGE CT
TEMECULA CA
92591-7315
US

V. Phone/Fax

Practice location:
  • Phone: 619-786-5835
  • Fax:
Mailing address:
  • Phone: 619-786-5835
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number48637
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: