Provider Demographics
NPI:1568237345
Name:SANDGREN, SAMANTHA (MA, LPCC)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:SANDGREN
Suffix:
Gender:F
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 CARISSA CIR
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80127-4305
Mailing Address - Country:US
Mailing Address - Phone:612-267-7784
Mailing Address - Fax:
Practice Address - Street 1:777 S WADSWORTH BLVD STE 102
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80226-4300
Practice Address - Country:US
Practice Address - Phone:913-208-4241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-21
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPCC.0021328101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health