Provider Demographics
NPI:1720194814
Name:SANDBURG, KARYN M (PSYCH MFT)
Entity Type:Individual
Prefix:DR
First Name:KARYN
Middle Name:M
Last Name:SANDBURG
Suffix:
Gender:F
Credentials:PSYCH MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14751 PLAZA DRIVE STE F
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780
Mailing Address - Country:US
Mailing Address - Phone:714-665-4343
Mailing Address - Fax:714-544-4472
Practice Address - Street 1:14751 PLAZA DRIVE STE F
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780
Practice Address - Country:US
Practice Address - Phone:714-665-4343
Practice Address - Fax:714-544-4472
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY14450103T00000X
CAMFT16598106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist