Provider Demographics
NPI:1083341374
Name:SANFORD, EUGENIA TYHERIA LYNN (MA, LPCC)
Entity Type:Individual
Prefix:
First Name:EUGENIA
Middle Name:TYHERIA LYNN
Last Name:SANFORD
Suffix:
Gender:F
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 CHERRY AVE
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-4398
Mailing Address - Country:US
Mailing Address - Phone:303-905-5112
Mailing Address - Fax:
Practice Address - Street 1:5485 CONESTOGA CT STE 110B
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-2752
Practice Address - Country:US
Practice Address - Phone:303-905-5112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-05
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPCC.0019589101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health