Provider Demographics
NPI:1922139146
Name:LYALL, SANDRA (LMHC, NCC, CEAP)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:
Last Name:LYALL
Suffix:
Gender:F
Credentials:LMHC, NCC, CEAP
Other - Prefix:MRS
Other - First Name:SANDRA
Other - Middle Name:L
Other - Last Name:MORTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED, LMHC
Mailing Address - Street 1:7 EDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:EAST LONGMEADOW
Mailing Address - State:MA
Mailing Address - Zip Code:01028-1216
Mailing Address - Country:US
Mailing Address - Phone:413-525-8717
Mailing Address - Fax:
Practice Address - Street 1:50 MAPLE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01103-1979
Practice Address - Country:US
Practice Address - Phone:413-794-6604
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3834101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health