Provider Demographics
NPI:1932377553
Name:JOHN, SANDRA D (PMHCNS- BC)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:D
Last Name:JOHN
Suffix:
Gender:F
Credentials:PMHCNS- BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 HALF DOME WAY
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928-8445
Mailing Address - Country:US
Mailing Address - Phone:530-809-0409
Mailing Address - Fax:
Practice Address - Street 1:850 PALMETTO AVE
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-4027
Practice Address - Country:US
Practice Address - Phone:530-965-2603
Practice Address - Fax:530-343-3449
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-16
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15368106H00000X
CA261370163WP0808X
CA3107163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult