Healthcare Provider Details

I. General information

NPI: 1386002723
Provider Name (Legal Business Name): SANDI GRABASCH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SANDI BURDEN

II. Dates (important events)

Enumeration Date: 01/31/2016
Last Update Date: 04/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6550 COLUMBUS DR UNIT 3
LAS CRUCES NM
88011-6130
US

IV. Provider business mailing address

6550 COLUMBUS DR UNIT 3
LAS CRUCES NM
88011-6130
US

V. Phone/Fax

Practice location:
  • Phone: 419-204-6612
  • Fax:
Mailing address:
  • Phone: 419-204-6612
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberT-0179241
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: