Provider Demographics
NPI:1659494664
Name:ERDELAC, SANDRA LYNN (LMFT)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:LYNN
Last Name:ERDELAC
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MISS
Other - First Name:SANDRA
Other - Middle Name:LYNN
Other - Last Name:BOTELLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12501 IMPERIAL HWY STE 400
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90650-1419
Mailing Address - Country:US
Mailing Address - Phone:818-807-6100
Mailing Address - Fax:562-807-6111
Practice Address - Street 1:12501 IMPERIAL HWY STE 400
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-1419
Practice Address - Country:US
Practice Address - Phone:818-807-6100
Practice Address - Fax:562-807-6111
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT47800106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist