Provider Demographics
NPI:1528197928
Name:PARENT, SANDRA L (MALLP)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:L
Last Name:PARENT
Suffix:
Gender:F
Credentials:MALLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17786 HEATH ST
Mailing Address - Street 2:
Mailing Address - City:BROWNSTOWN
Mailing Address - State:MI
Mailing Address - Zip Code:48193-8808
Mailing Address - Country:US
Mailing Address - Phone:313-304-6352
Mailing Address - Fax:313-291-0942
Practice Address - Street 1:806 OAKWOOD BLVD
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-2319
Practice Address - Country:US
Practice Address - Phone:313-304-6352
Practice Address - Fax:313-221-9998
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-04
Last Update Date:2017-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301012588103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist