Provider Demographics
NPI:1336663228
Name:SANDBEK, CARLA (LCSW)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:
Last Name:SANDBEK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1113 E HACKAMORE DR
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-8515
Mailing Address - Country:US
Mailing Address - Phone:801-577-3564
Mailing Address - Fax:
Practice Address - Street 1:3375 W MAYFLOWER WAY STE A
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-3135
Practice Address - Country:US
Practice Address - Phone:801-331-6775
Practice Address - Fax:801-766-2010
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-01
Last Update Date:2017-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5522589-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT5522589-3501OtherDOPL