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NPI Code Detail

MEDICARE: SUSAN LEIGH SANDOVAL C.A.T.

MEDICARE: SUSAN LEIGH SANDOVAL C.A.T.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) CounselorACC.0021272CO
2101YA0400XAddiction (Substance Use Disorder) CounselorLAC01832KS
3101YA0400XAddiction (Substance Use Disorder) CounselorACA.0008128CO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1ACC.0021272OTHERCOCOLORADO DEPARTMENT OF REGULATORY AGENCIES
2LAC01832OTHERKSKANSAS BEHAVIORAL SCIENCES REGULATORY BOARD

General Provider Information

NPI Number : 1477207843
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUSAN LEIGH SANDOVAL C.A.T.
Provider Business Mailing Address
First Line : 2485 TOWER AVE
Second Line :
City : BURLINGTON
State : CO
Zip : 80807-2613
Country : US
Telephone Number : 719-342-0586
Fax Number :
Provider Business Practice Location Address
First Line : 451 14TH ST
Second Line :
City : BURLINGTON
State : CO
Zip : 80807-1609
Country : US
Telephone Number : 719-297-1818
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/04/2022
Last Update Date : 03/21/2023

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