Provider Demographics
NPI:1265619472
Name:GABELL, SANDRA JACQUIN (MED)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:JACQUIN
Last Name:GABELL
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 BRISTLECONE PINES RD
Mailing Address - Street 2:
Mailing Address - City:SEDONA
Mailing Address - State:AZ
Mailing Address - Zip Code:86336-4933
Mailing Address - Country:US
Mailing Address - Phone:928-204-6508
Mailing Address - Fax:
Practice Address - Street 1:25 W SADDLEHORN RD
Practice Address - Street 2:BIG PARK COMMUNITY SCHOOL
Practice Address - City:SEDONA
Practice Address - State:AZ
Practice Address - Zip Code:86351-7572
Practice Address - Country:US
Practice Address - Phone:928-204-6508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-30
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool