Provider Demographics
NPI:1346487022
Name:ELDER, SANDRA LEE (MS, LPC)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:LEE
Last Name:ELDER
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2643 HUNTINGDON PIKE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19006-5109
Mailing Address - Country:US
Mailing Address - Phone:267-474-0789
Mailing Address - Fax:
Practice Address - Street 1:2643 HUNTINGDON PIKE
Practice Address - Street 2:
Practice Address - City:HUNTINGDON VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19006-5109
Practice Address - Country:US
Practice Address - Phone:267-474-0789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-16
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC007015101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA46-3351214OtherIRS