Provider Demographics
NPI:1336912906
Name:SANFORD, HEATHER ANN (MFT- A, LPC-A)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:ANN
Last Name:SANFORD
Suffix:
Gender:F
Credentials:MFT- A, LPC-A
Other - Prefix:MRS
Other - First Name:HEATHER
Other - Middle Name:MCGOWEN
Other - Last Name:SANFORD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3040 SPANISH OAK TRL
Mailing Address - Street 2:
Mailing Address - City:MELISSA
Mailing Address - State:TX
Mailing Address - Zip Code:75454-2657
Mailing Address - Country:US
Mailing Address - Phone:951-428-7769
Mailing Address - Fax:
Practice Address - Street 1:3040 SPANISH OAK TRL
Practice Address - Street 2:
Practice Address - City:MELISSA
Practice Address - State:TX
Practice Address - Zip Code:75454-2657
Practice Address - Country:US
Practice Address - Phone:951-428-7769
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-06
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX91381101YP2500X
TX205020106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional