Provider Demographics
NPI:1164895710
Name:SANDOVAL, JOSE (MSSW, LCDC)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:
Last Name:SANDOVAL
Suffix:
Gender:M
Credentials:MSSW, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 N WARE RD
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-6616
Mailing Address - Country:US
Mailing Address - Phone:956-664-0057
Mailing Address - Fax:956-664-2846
Practice Address - Street 1:701 N WARE RD
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-6616
Practice Address - Country:US
Practice Address - Phone:956-664-0057
Practice Address - Fax:956-664-2846
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-04
Last Update Date:2020-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12499101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)