Provider Demographics
NPI:1184802167
Name:SANDRA CARLSON & ASSOCIATES
Entity type:Organization
Organization Name:SANDRA CARLSON & ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARLSON
Authorized Official - Suffix:III
Authorized Official - Credentials:LCPC
Authorized Official - Phone:630-771-0144
Mailing Address - Street 1:682 W BOUGHTON RD STE D
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-2199
Mailing Address - Country:US
Mailing Address - Phone:630-771-0144
Mailing Address - Fax:630-771-9520
Practice Address - Street 1:682 W BOUGHTON RD STE D
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-2199
Practice Address - Country:US
Practice Address - Phone:630-771-0144
Practice Address - Fax:630-771-9520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-01
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL09932036OtherBLUE CROSS BLUE SHIELD