Healthcare Provider Details

I. General information

NPI: 1174127922
Provider Name (Legal Business Name): LOIS J SANDLAND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2020
Last Update Date: 12/21/2020
Certification Date: 12/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 N ACADEMY BLVD STE 2802020
COLORADO SPRINGS CO
80909-1567
US

IV. Provider business mailing address

484 N IDLEDALE DR
PUEBLO WEST CO
81007-1145
US

V. Phone/Fax

Practice location:
  • Phone: 970-825-6597
  • Fax:
Mailing address:
  • Phone: 719-232-0975
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: LOIS J SANDLAND
Title or Position: OWNER
Credential: LCSW
Phone: 719-232-0975