Provider Demographics
NPI:1225352412
Name:NOVAK, SANDRA J (MS, MA, SEP, LPC)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:J
Last Name:NOVAK
Suffix:
Gender:F
Credentials:MS, MA, SEP, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1480 LEE HILL RD UNIT 7
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-0872
Mailing Address - Country:US
Mailing Address - Phone:303-629-2960
Mailing Address - Fax:303-443-1093
Practice Address - Street 1:1480 LEE HILL RD UNIT 7
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-0872
Practice Address - Country:US
Practice Address - Phone:303-629-2960
Practice Address - Fax:303-443-1093
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-17
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2011101YP2500X
106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist