Provider Demographics
NPI:1285214064
Name:KHALIL, SANDRA RULA (LMFT)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:RULA
Last Name:KHALIL
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 WOODBRIDGE PKWY STE 300
Mailing Address - Street 2:
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098-7122
Mailing Address - Country:US
Mailing Address - Phone:214-888-6526
Mailing Address - Fax:
Practice Address - Street 1:505 WOODBRIDGE PKWY STE 300
Practice Address - Street 2:
Practice Address - City:WYLIE
Practice Address - State:TX
Practice Address - Zip Code:75098-7122
Practice Address - Country:US
Practice Address - Phone:214-888-6526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-14
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX203375101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health