Most Relevant Information
Provider Data
| NPI Number: | 1003545518 |
| Provider Name: | MARY SANDOVAL LCPC |
| Entity Type: | Individual |
| Taxonomy Code: | 101YM0800X |
| Specialty: | Counselor |
| License Number: | BBH-LCPC-LIC-53516 |
Most Important Dates
| Enumeration Date: | 06/09/2022 |
| Last Updated: | 06/09/2022 |
Provider Practice Location
200 POLK ST
ANACONDA
MT
597119611
Practice Location Phone/Fax
| Phone: | 4066912075 |
| Fax: |
Provider Mailing Location
200 POLK ST
ANACONDA
MT
597119611
Provider Mailing Phone/Fax
| Phone: | 4066912075 |
| Fax: |