Provider Demographics
NPI:1356092977
Name:NEIMAN, SANDI ELLEN
Entity Type:Individual
Prefix:
First Name:SANDI
Middle Name:ELLEN
Last Name:NEIMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 MILL CREEK PATH
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78633-5406
Mailing Address - Country:US
Mailing Address - Phone:615-438-3964
Mailing Address - Fax:
Practice Address - Street 1:126 MILL CREEK PATH
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78633-5406
Practice Address - Country:US
Practice Address - Phone:615-438-3964
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-14
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX204357106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty