Provider Demographics
NPI:1942515424
Name:TUDOR, SANDRA ELIZABETH (MA, LMHCA)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:ELIZABETH
Last Name:TUDOR
Suffix:
Gender:F
Credentials:MA, LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27010 190TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98042-8486
Mailing Address - Country:US
Mailing Address - Phone:206-914-0426
Mailing Address - Fax:425-264-0548
Practice Address - Street 1:304 MAIN AVE S
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-2758
Practice Address - Country:US
Practice Address - Phone:206-914-0426
Practice Address - Fax:425-264-0548
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-09
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC60273486101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health