Active NPI
Mary Sandoval, LCPC
- Professional Counselor
- Anaconda, MT
National Provider Identifier
1003545518
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- BBH-LCPC-LIC-53516
- Practice address
- 200 Polk St
Anaconda, MT 59711-9611 - Phone
- (406) 691-2075
- NPI assigned
- Jun 9, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | BBH-LCPC-LIC-53516 | MT | Primary |
Addresses
Primary practice location
200 Polk St
Anaconda, MT 59711-9611
Mailing address
200 Polk St
Anaconda, MT 59711-9611
Phone (406) 691-2075
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MT
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Mental Health Counselor
- Education
- Other, 2017
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
205 E Park Ave
Anaconda, MT 59711-2340
264 Cobblestone LN
McDonough, GA 30252-6254
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| BBH-LCPC-LIC-53516 | MT | MD | Professional Counselor |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Community/Behavioral Health Agency
- Anaconda, MT
- NPI 1427003862
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1654732800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1768435200000",
"number": "1003545518",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "200 POLK ST",
"city": "ANACONDA",
"state": "MT",
"postal_code": "597119611",
"telephone_number": "406-691-2075"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 POLK ST",
"city": "ANACONDA",
"state": "MT",
"postal_code": "597119611",
"telephone_number": "406-691-2075"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SANDOVAL",
"first_name": "MARY",
"credential": "LCPC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-06-09",
"last_updated": "2026-01-15",
"certification_date": "2026-01-15",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "MT",
"license": "BBH-LCPC-LIC-53516",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Anaconda, MT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.