Provider Demographics
NPI:1578774204
Name:AMES, SANDRA LOUISE (MASTERS)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:LOUISE
Last Name:AMES
Suffix:
Gender:F
Credentials:MASTERS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 LOCUST ST.
Mailing Address - Street 2:
Mailing Address - City:CENTRALIA
Mailing Address - State:WA
Mailing Address - Zip Code:98531
Mailing Address - Country:US
Mailing Address - Phone:360-807-0524
Mailing Address - Fax:360-807-0524
Practice Address - Street 1:208 W LOCUST ST
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:WA
Practice Address - Zip Code:98531-4007
Practice Address - Country:US
Practice Address - Phone:360-807-0524
Practice Address - Fax:360-807-0524
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00052316101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health