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General NPI Number Information
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NPI Number | 1285964882
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Entity Type | Individual
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Provider Name | ERIN LEVERENZ SANDOVAL PH.D.
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Gender | Female
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Dates
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Enumeration Date | 01/04/2010
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Last Update Date | 01/04/2010
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Provider Practice Location Address
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Address Line | 2554 E VILLA MARIA RD
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City | BRYAN
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State | TX
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Zip | 77802-2037
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Country | US
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Telephone | 979-777-7904
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Fax |
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Provider Business Mailing Address
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Address Line | 4603 PARK RDG
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City | BRYAN
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State | TX
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Zip | 77802-5852
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Country | US
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Telephone | 979-777-7904
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Fax | 979-774-0316
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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 | 34241
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License Number State | TX
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