Provider Demographics
NPI:1326322033
Name:SANDCREEK BEHAVIORAL HEALTH GROUP, LLC
Entity Type:Organization
Organization Name:SANDCREEK BEHAVIORAL HEALTH GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOY
Authorized Official - Middle Name:
Authorized Official - Last Name:HOOFER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:316-212-6287
Mailing Address - Street 1:2629 TILBURY LN
Mailing Address - Street 2:
Mailing Address - City:HALSTEAD
Mailing Address - State:KS
Mailing Address - Zip Code:67056-9377
Mailing Address - Country:US
Mailing Address - Phone:316-212-6287
Mailing Address - Fax:
Practice Address - Street 1:120 W 6TH ST
Practice Address - Street 2:SUITE 160
Practice Address - City:NEWTON
Practice Address - State:KS
Practice Address - Zip Code:67114-2155
Practice Address - Country:US
Practice Address - Phone:316-212-6287
Practice Address - Fax:316-283-1142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-30
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1658103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty