Provider Demographics
NPI:1174393573
Name:SANDYDAVISLPC LLC
Entity type:Organization
Organization Name:SANDYDAVISLPC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:636-232-0340
Mailing Address - Street 1:13023 TESSON FERRY RD STE 103
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-3480
Mailing Address - Country:US
Mailing Address - Phone:636-232-0340
Mailing Address - Fax:636-600-8714
Practice Address - Street 1:13023 TESSON FERRY RD STE 103
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-3480
Practice Address - Country:US
Practice Address - Phone:636-232-0340
Practice Address - Fax:636-600-8714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-05
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health