Provider Demographics
NPI:1255959391
Name:SANDOVAL, JACOB ANDREW (PHD, LMFT)
Entity type:Individual
Prefix:DR
First Name:JACOB
Middle Name:ANDREW
Last Name:SANDOVAL
Suffix:
Gender:M
Credentials:PHD, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6732 W COAL MINE AVE STE 139
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80123-4573
Mailing Address - Country:US
Mailing Address - Phone:563-213-5082
Mailing Address - Fax:303-496-0786
Practice Address - Street 1:1942 BROADWAY STE 314C
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-5233
Practice Address - Country:US
Practice Address - Phone:319-855-7899
Practice Address - Fax:303-496-0786
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-06
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA100407106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist