Provider Demographics
NPI:1114974250
Name:SANDBEK, TERENCE J (PHD)
Entity Type:Individual
Prefix:DR
First Name:TERENCE
Middle Name:J
Last Name:SANDBEK
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:TERRY
Other - Middle Name:J
Other - Last Name:SANDBEK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:4366 AUBURN BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95841-4107
Mailing Address - Country:US
Mailing Address - Phone:916-489-1774
Mailing Address - Fax:916-834-0389
Practice Address - Street 1:4366 AUBURN BLVD STE 101
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95841
Practice Address - Country:US
Practice Address - Phone:916-489-1774
Practice Address - Fax:916-834-0389
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-27
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY06989103TC0700X
CAPSY6989103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
100050031002OtherPSYCHOLOGY