=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538211701
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAN M SANFORD LPC-MH, QMHP, LSWA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/17/2007
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 309 2ND AVE SE
-----------------------------------------------------
City | WATERTOWN
-----------------------------------------------------
State | SD
-----------------------------------------------------
Zip | 57201-3621
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 605-886-6321
-----------------------------------------------------
Fax | 605-886-6306
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 309 2ND AVE SE
-----------------------------------------------------
City | WATERTOWN
-----------------------------------------------------
State | SD
-----------------------------------------------------
Zip | 57201-3621
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 605-886-6321
-----------------------------------------------------
Fax | 605-886-6306
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | LPC-MH 2087
-----------------------------------------------------
License Number State | SD
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | LPC-MH 2087
-----------------------------------------------------
License Number State | SD
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | LSWA 2146
-----------------------------------------------------
License Number State | SD
-----------------------------------------------------