MEDICARE: PETER SANDOVAL PLPC

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
1	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1881095313
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PETER SANDOVAL PLPC

Provider Business Mailing Address
First Line	:	9666 OLIVE BLVD
Second Line	:	SUITE 400
City	:	SAINT LOUIS
State	:	MO
Zip	:	63132-3013
Country	:	US
Telephone Number	:	314-785-7316
Fax Number	:

Provider Business Practice Location Address
First Line	:	9666 OLIVE BLVD
Second Line	:	SUITE 400
City	:	SAINT LOUIS
State	:	MO
Zip	:	63132-3013
Country	:	US
Telephone Number	:	314-785-7316
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/16/2014
Last Update Date	:	09/16/2014

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Directions to “ PETER SANDOVAL PLPC” Practice Location

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