Provider Demographics
NPI:1497813620
Name:HARAM, SANDRA J (PHD)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:J
Last Name:HARAM
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2720 MELROSE DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-1931
Mailing Address - Country:US
Mailing Address - Phone:972-596-4631
Mailing Address - Fax:972-644-8557
Practice Address - Street 1:1401 N CENTRAL EXPY
Practice Address - Street 2:SUITE 375
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-4669
Practice Address - Country:US
Practice Address - Phone:972-644-8077
Practice Address - Fax:972-644-8557
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10647101YP2500X
TX142106H00000X
TX507125363LP0808X, 364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1100067-04Medicaid
TXCN0022Medicare ID - Type Unspecified
TX1100067-04Medicaid