Provider Demographics
NPI:1205445731
Name:KILLEBREW, SANDRA (LMFT)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:KILLEBREW
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4041 RUSTON WAY STE 202
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98402-5300
Mailing Address - Country:US
Mailing Address - Phone:425-998-8831
Mailing Address - Fax:
Practice Address - Street 1:4041 RUSTON WAY STE 202
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-5300
Practice Address - Country:US
Practice Address - Phone:425-998-8831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-30
Last Update Date:2024-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11768842-3902101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health