Provider Demographics
NPI:1841724556
Name:WEBER, SANDRA (MA, LPC)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:WEBER
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17645 GRAMA RDG
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80908-1359
Mailing Address - Country:US
Mailing Address - Phone:347-852-0504
Mailing Address - Fax:
Practice Address - Street 1:17645 GRAMA RDG
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80908-1359
Practice Address - Country:US
Practice Address - Phone:347-852-0504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-19
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0015502101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional