Provider Demographics
NPI:1467523936
Name:STULTZ, SANDRA LANEAL (MFT)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:LANEAL
Last Name:STULTZ
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:MS
Other - First Name:SANDRA
Other - Middle Name:LANEAL
Other - Last Name:ARNOLD NELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MFTI
Mailing Address - Street 1:PO BOX 3230
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94578-0230
Mailing Address - Country:US
Mailing Address - Phone:510-395-4814
Mailing Address - Fax:
Practice Address - Street 1:401 GRAND AVE
Practice Address - Street 2:SUITE 380
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94610-5054
Practice Address - Country:US
Practice Address - Phone:510-395-4814
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43047106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist