=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023029949
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AARON VICTOR SANBORN LPC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/10/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1602 10TH ST
-----------------------------------------------------
City | LUBBOCK
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79401-2607
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 806-766-0310
-----------------------------------------------------
Fax | 806-744-9580
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1602 10TH ST
-----------------------------------------------------
City | LUBBOCK
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79401-2607
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 806-766-0310
-----------------------------------------------------
Fax | 806-744-9580
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number | 12380
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------