Provider Demographics
NPI:1912414541
Name:SANFORD, DIANN LYNN (PSYD,LP,LPC)
Entity Type:Individual
Prefix:
First Name:DIANN
Middle Name:LYNN
Last Name:SANFORD
Suffix:
Gender:F
Credentials:PSYD,LP,LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1820 PRESTON PARK BLVD STE 2200
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-3614
Mailing Address - Country:US
Mailing Address - Phone:972-589-8121
Mailing Address - Fax:
Practice Address - Street 1:1820 PRESTON PARK BLVD STE 2200
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-3614
Practice Address - Country:US
Practice Address - Phone:972-589-8121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-04
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX74944101YP2500X
TX38403103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional