Provider Demographics
NPI:1932325875
Name:BURNINGHAM, SANDI K (LPC, LSAC)
Entity Type:Individual
Prefix:MRS
First Name:SANDI
Middle Name:K
Last Name:BURNINGHAM
Suffix:
Gender:F
Credentials:LPC, LSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:561 E TABERNACLE ST
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-2944
Mailing Address - Country:US
Mailing Address - Phone:435-673-2822
Mailing Address - Fax:435-673-0943
Practice Address - Street 1:561 E TABERNACLE ST
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-2944
Practice Address - Country:US
Practice Address - Phone:435-673-2822
Practice Address - Fax:435-673-0943
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT350065-6006101YA0400X
UT350065-6004101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT11654728OtherCAQH CREDENTIALING #