Provider Demographics
NPI:1003169905
Name:SANDOVAL, MICHELLE V (LCSW)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:V
Last Name:SANDOVAL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1825 PINION RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:ELKO
Mailing Address - State:NV
Mailing Address - Zip Code:89801-8319
Mailing Address - Country:US
Mailing Address - Phone:775-434-9011
Mailing Address - Fax:775-738-8842
Practice Address - Street 1:1825 PINION RD
Practice Address - Street 2:SUITE A
Practice Address - City:ELKO
Practice Address - State:NV
Practice Address - Zip Code:89801-8319
Practice Address - Country:US
Practice Address - Phone:775-434-9011
Practice Address - Fax:775-738-8842
Is Sole Proprietor?:No
Enumeration Date:2012-10-17
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6292-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical