Provider Demographics
NPI:1093895153
Name:GODFREY, SANDRA D (MA, LCPC, LMFT)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:D
Last Name:GODFREY
Suffix:
Gender:F
Credentials:MA, LCPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3424 6TH ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-5183
Mailing Address - Country:US
Mailing Address - Phone:208-413-1506
Mailing Address - Fax:208-798-1605
Practice Address - Street 1:0309 2ND ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-2163
Practice Address - Country:US
Practice Address - Phone:208-746-0137
Practice Address - Fax:298-746-8685
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC 3227101YP2500X
CA30314106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist