Provider Demographics
NPI:1518506195
Name:SUNDELL, CARLIN
Entity Type:Individual
Prefix:MR
First Name:CARLIN
Middle Name:
Last Name:SUNDELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 W HIGHWAY 246
Mailing Address - Street 2:
Mailing Address - City:BUELLTON
Mailing Address - State:CA
Mailing Address - Zip Code:93427-9459
Mailing Address - Country:US
Mailing Address - Phone:805-686-8555
Mailing Address - Fax:
Practice Address - Street 1:195 W HIGHWAY 246
Practice Address - Street 2:
Practice Address - City:BUELLTON
Practice Address - State:CA
Practice Address - Zip Code:93427-9459
Practice Address - Country:US
Practice Address - Phone:805-686-8555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-31
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health