Healthcare Provider Details

I. General information

NPI: 1992649768
Provider Name (Legal Business Name): JUSTIN SANDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2026
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 INVERNESS DR STE 400
COLORADO SPRINGS CO
80910-3739
US

IV. Provider business mailing address

1820 SCHOLAR PT APT 727
COLORADO SPRINGS CO
80905-8333
US

V. Phone/Fax

Practice location:
  • Phone: 719-649-1902
  • Fax:
Mailing address:
  • Phone: 609-306-9564
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPCC.0024514
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: