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General NPI Number Information
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NPI Number | 1053868398
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Entity Type | Individual
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Provider Name | SANDRA CARRASCO LMFT, LPC
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Gender | Female
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Dates
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Enumeration Date | 09/02/2016
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Last Update Date | 09/27/2017
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Provider Practice Location Address
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Address Line | 4500 W ILLINOIS AVE
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City | MIDLAND
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State | TX
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Zip | 79703-5491
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Country | US
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Telephone | 432-219-2799
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Fax |
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Provider Business Mailing Address
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Address Line | 4500 W ILLINOIS AVE STE 310D
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City | MIDLAND
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State | TX
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Zip | 79703-5428
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Country | US
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Telephone | 432-219-2799
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 68841
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 201698
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License Number State | TX
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