Provider Demographics
NPI:1609108125
Name:SANDOVAL, ANITA (LPC)
Entity Type:Individual
Prefix:MRS
First Name:ANITA
Middle Name:
Last Name:SANDOVAL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:ANITA
Other - Middle Name:PATRICIA
Other - Last Name:SANDOVAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:2802 E 20TH ST
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-3337
Mailing Address - Country:US
Mailing Address - Phone:956-314-0794
Mailing Address - Fax:
Practice Address - Street 1:402 S NEBRASKA AVE
Practice Address - Street 2:
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596-6024
Practice Address - Country:US
Practice Address - Phone:956-314-0794
Practice Address - Fax:956-271-0378
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-09
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63703101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional