Provider Demographics
NPI:1770896375
Name:SANDOVAL, MARIA GUADALUPE (LMFT)
Entity type:Individual
Prefix:MS
First Name:MARIA
Middle Name:GUADALUPE
Last Name:SANDOVAL
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:P.O. BOX 1214
Mailing Address - Street 2:
Mailing Address - City:LOMPOC
Mailing Address - State:CA
Mailing Address - Zip Code:93438
Mailing Address - Country:US
Mailing Address - Phone:805-878-3955
Mailing Address - Fax:805-922-4797
Practice Address - Street 1:111 SOUTH I ST.
Practice Address - Street 2:SUITE 1C
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436
Practice Address - Country:US
Practice Address - Phone:805-878-3955
Practice Address - Fax:805-922-4797
Is Sole Proprietor?:No
Enumeration Date:2010-07-23
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CALMFT101787101YM0800X
CA101787106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health