Provider Demographics
NPI:1629611553
Name:GERDES, SANDRA ELENA (LPC)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:ELENA
Last Name:GERDES
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:351 E CIVIC CENTER DR APT 2003
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-3451
Mailing Address - Country:US
Mailing Address - Phone:520-838-1582
Mailing Address - Fax:
Practice Address - Street 1:1955 S VAL VISTA DR STE 120
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-7372
Practice Address - Country:US
Practice Address - Phone:520-838-1582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-23
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ17148101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health