Provider Demographics
NPI:1386002723
Name:GRABASCH, SANDI
Entity Type:Individual
Prefix:
First Name:SANDI
Middle Name:
Last Name:GRABASCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SANDI
Other - Middle Name:
Other - Last Name:BURDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6550 COLUMBUS DR UNIT 3
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-6130
Mailing Address - Country:US
Mailing Address - Phone:419-204-6612
Mailing Address - Fax:
Practice Address - Street 1:6550 COLUMBUS DR UNIT 3
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-6130
Practice Address - Country:US
Practice Address - Phone:419-204-6612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-31
Last Update Date:2018-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMT-0179241106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist