Provider Demographics
NPI:1174830582
Name:MORAN, SANDRA E (MS, LMHC)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:E
Last Name:MORAN
Suffix:
Gender:F
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1307 N ARBOGAST ST
Mailing Address - Street 2:
Mailing Address - City:GRIFFITH
Mailing Address - State:IN
Mailing Address - Zip Code:46319-1844
Mailing Address - Country:US
Mailing Address - Phone:219-680-9743
Mailing Address - Fax:219-923-3060
Practice Address - Street 1:1307 N ARBOGAST ST
Practice Address - Street 2:
Practice Address - City:GRIFFITH
Practice Address - State:IN
Practice Address - Zip Code:46319-1844
Practice Address - Country:US
Practice Address - Phone:219-680-9743
Practice Address - Fax:219-923-3060
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-07
Last Update Date:2013-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39002112A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health