Provider Demographics
NPI:1891040515
Name:HILL, SANDRA JEAN (LPC)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:JEAN
Last Name:HILL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:SANDY
Other - Middle Name:JEAN
Other - Last Name:HILL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:314 N MUSKOGEE AVE
Mailing Address - Street 2:
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74464-2738
Mailing Address - Country:US
Mailing Address - Phone:190-422-8769
Mailing Address - Fax:
Practice Address - Street 1:314 N MUSKOGEE AVE
Practice Address - Street 2:
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464-2738
Practice Address - Country:US
Practice Address - Phone:190-422-8769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-18
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1910101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional