Provider Demographics
NPI:1619257516
Name:SANDLAND, LOIS J (LCSW)
Entity Type:Individual
Prefix:
First Name:LOIS
Middle Name:J
Last Name:SANDLAND
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:484 N IDLEDALE DR
Mailing Address - Street 2:
Mailing Address - City:PUEBLO WEST
Mailing Address - State:CO
Mailing Address - Zip Code:81007-1145
Mailing Address - Country:US
Mailing Address - Phone:719-232-0975
Mailing Address - Fax:
Practice Address - Street 1:2020 N ACADEMY BLVD STE 280
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-1568
Practice Address - Country:US
Practice Address - Phone:719-232-0975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-23
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
COCSW.00002075101YM0800X
SW16118101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health