Provider Demographics
NPI:1396042958
Name:SANDOVAL, ERIC STEVEN SR (CACII)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:STEVEN
Last Name:SANDOVAL
Suffix:SR
Gender:M
Credentials:CACII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 CARBON PLACE
Mailing Address - Street 2:
Mailing Address - City:TRINIDAD
Mailing Address - State:CO
Mailing Address - Zip Code:81082
Mailing Address - Country:US
Mailing Address - Phone:719-846-4153
Mailing Address - Fax:
Practice Address - Street 1:1004 CARBON
Practice Address - Street 2:
Practice Address - City:TRINIDAD
Practice Address - State:CO
Practice Address - Zip Code:81082-3664
Practice Address - Country:US
Practice Address - Phone:719-846-4153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-17
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACB-6520101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor