Provider Demographics
NPI:1922684745
Name:SANDOVAL, LAURA YVETTE (LPC, LCDC)
Entity Type:Individual
Prefix:MISS
First Name:LAURA
Middle Name:YVETTE
Last Name:SANDOVAL
Suffix:
Gender:F
Credentials:LPC, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:955 WATER ST
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028-3508
Mailing Address - Country:US
Mailing Address - Phone:830-257-6553
Mailing Address - Fax:
Practice Address - Street 1:955 WATER ST
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-3508
Practice Address - Country:US
Practice Address - Phone:830-257-6553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-22
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX82520101YP2500X
TX14840101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)