Provider Demographics
NPI:1184325706
Name:SANCHEZ, EVITA MICHELLE (MS, LMFT)
Entity type:Individual
Prefix:
First Name:EVITA
Middle Name:MICHELLE
Last Name:SANCHEZ
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8121 PORTLAND AVE S
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55420-1318
Mailing Address - Country:US
Mailing Address - Phone:952-486-3541
Mailing Address - Fax:
Practice Address - Street 1:711 W LAKE ST
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-2918
Practice Address - Country:US
Practice Address - Phone:651-321-1515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-10
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3670106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist