Provider Demographics
NPI:1790467496
Name:ESPE, SANDRA COLLEEN (LPCC)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:COLLEEN
Last Name:ESPE
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1002 PARK AVE N
Mailing Address - Street 2:
Mailing Address - City:PARK RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:56470-9541
Mailing Address - Country:US
Mailing Address - Phone:218-252-6630
Mailing Address - Fax:
Practice Address - Street 1:207 PARK AVE S STE 2
Practice Address - Street 2:
Practice Address - City:PARK RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:56470-1531
Practice Address - Country:US
Practice Address - Phone:218-255-3321
Practice Address - Fax:218-237-8135
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-02
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3892101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty