Provider Demographics
NPI:1982944609
Name:SANDGREN, DEBRA MARIE (LMFT)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:MARIE
Last Name:SANDGREN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:DEBBIE
Other - Middle Name:MARIE
Other - Last Name:SANDGREN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:30271 SILVER RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-7315
Mailing Address - Country:US
Mailing Address - Phone:619-786-5835
Mailing Address - Fax:
Practice Address - Street 1:135 E 3RD AVE STE B
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-4252
Practice Address - Country:US
Practice Address - Phone:619-786-5835
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-15
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48637101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health