Provider Demographics
NPI:1972659092
Name:SANDLIN, BRAD K I (LPC)
Entity Type:Individual
Prefix:MR
First Name:BRAD
Middle Name:K
Last Name:SANDLIN
Suffix:I
Gender:M
Credentials:LPC
Other - Prefix:MR
Other - First Name:BRAD
Other - Middle Name:K
Other - Last Name:SANDLIN
Other - Suffix:I
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:410 DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75401-6049
Mailing Address - Country:US
Mailing Address - Phone:469-222-0563
Mailing Address - Fax:
Practice Address - Street 1:7808 CLODUS FIELDS DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75251-2206
Practice Address - Country:US
Practice Address - Phone:972-701-3637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12743101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional