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General NPI Number Information
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NPI Number | 1164512604
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Entity Type | Individual
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Provider Name | SANDRA LYNN CANTRELL LMFT
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Gender | Female
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Dates
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Enumeration Date | 10/13/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 948 11TH ST STE 11B
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City | MODESTO
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State | CA
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Zip | 95354-2339
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Country | US
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Telephone | 209-614-8226
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Fax | 209-576-1470
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Provider Business Mailing Address
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Address Line | PO BOX 323
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City | HILMAR
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State | CA
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Zip | 95324-0323
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Country | US
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Telephone | 209-667-0396
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Fax | 209-576-1470
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFC39505
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License Number State | CA
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