Provider Demographics
NPI:1710177423
Name:GARTIN, SANDRA R (MA, MFT)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:R
Last Name:GARTIN
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1226 SMITHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-1127
Mailing Address - Country:US
Mailing Address - Phone:310-557-1616
Mailing Address - Fax:310-557-1616
Practice Address - Street 1:315 S BEVERLY DR STE 307
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-4309
Practice Address - Country:US
Practice Address - Phone:213-359-6185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-29
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC44671106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist