Provider Demographics
NPI:1417132655
Name:MUNN, SANDRA KAY (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:KAY
Last Name:MUNN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:SANDRA
Other - Middle Name:KAY
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:66 W HARDING AVE STE C4
Mailing Address - Street 2:
Mailing Address - City:CEDAR CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84720-3091
Mailing Address - Country:US
Mailing Address - Phone:435-531-3139
Mailing Address - Fax:435-586-4268
Practice Address - Street 1:66 W HARDING AVE STE C4
Practice Address - Street 2:
Practice Address - City:CEDAR CITY
Practice Address - State:UT
Practice Address - Zip Code:84720-3091
Practice Address - Country:US
Practice Address - Phone:435-531-3139
Practice Address - Fax:435-586-4268
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-07
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5430637-3501101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health