Healthcare Provider Details

I. General information

NPI: 1265662324
Provider Name (Legal Business Name): SANDRA J EARL M.A. L.P.C.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SANDRA EARL INC LPCC

II. Dates (important events)

Enumeration Date: 07/22/2009
Last Update Date: 11/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1813 HOPI RD
SANTA FE NM
87505-3308
US

IV. Provider business mailing address

1813 HOPI RD
SANTA FE NM
87505-3308
US

V. Phone/Fax

Practice location:
  • Phone: 505-660-3607
  • Fax:
Mailing address:
  • Phone: 505-660-3607
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1216
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: