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General NPI Number Information
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NPI Number | 1063524312
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Entity Type | Individual
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Provider Name | SANDRA L BRANTON EDD
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Gender | Female
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 09/18/2009
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Provider Practice Location Address
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Address Line | 870 EMERALD BAY RD SUITE 305
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City | SOUTH LAKE TAHOE
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State | CA
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Zip | 96150-9403
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Country | US
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Telephone | 530-541-5977
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Fax | 530-577-4686
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Provider Business Mailing Address
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Address Line | PO BOX 550547
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City | SOUTH LAKE TAHOE
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State | CA
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Zip | 96155-0010
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Country | US
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Telephone | 530-541-5977
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Fax | 530-577-4686
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY11992
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PY0299
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License Number State | NV
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFC18217
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License Number State | CA
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