Healthcare Provider Details

I. General information

NPI: 1124019120
Provider Name (Legal Business Name): SANDRA K PRATT LMT, LMFT, SEP, OB
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2321 CAGUA DR NE
ALBUQUERQUE NM
87110-4105
US

IV. Provider business mailing address

540 CHAMA ST NE SUITE 2
ALBUQUERQUE NM
87108-3594
US

V. Phone/Fax

Practice location:
  • Phone: 505-888-9476
  • Fax:
Mailing address:
  • Phone: 505-265-0753
  • Fax: 505-268-5722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: