Healthcare Provider Details

I. General information

NPI: 1043403058
Provider Name (Legal Business Name): KAREN RUTH SANDS MA LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2007
Last Update Date: 08/22/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2795 VIA CABALLERO DEL SUR
SANTA FE NM
87505
US

IV. Provider business mailing address

2795 VIA CABALLERO DEL SUR
SANTA FE NM
87505
US

V. Phone/Fax

Practice location:
  • Phone: 505-982-5015
  • Fax: 505-216-9758
Mailing address:
  • Phone: 505-982-5015
  • Fax: 505-216-9758

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPCC0770
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLMSWM1665
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: