Provider Demographics
NPI:1811078702
Name:SANDORSKEY, STACY DEE ANN (LPC)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:DEE ANN
Last Name:SANDORSKEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2733 MOHAWK DR
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79109-4733
Mailing Address - Country:US
Mailing Address - Phone:806-681-8686
Mailing Address - Fax:
Practice Address - Street 1:2733 MOHAWK DR
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109-4733
Practice Address - Country:US
Practice Address - Phone:806-681-8686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16940101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX140793401Medicaid
TX140793402Medicaid