Sandra L Eickmann, MA, MPH, LPC

Individual provider Active NPI Professional Counselor · Berthoud, CO

NPI 1013073642 · NPPES record last updated Sep 22, 2015

Key facts

NPI
1013073642
Entity type
Individual (NPI type 1)
Primary specialty
Professional Counselor 101YP2500X
License
LPC.0011233 (CO)
Practice address
1515 Diamond Wall Dr
Berthoud, CO 80513-8449
Phone
(970) 460-8477
Fax
(970) 460-7226
NPI assigned
Dec 28, 2006
Sex
Female
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No
Credentials
Master of Arts

State licenses

LicenseStateTypeSpecialty
LPC.0011233COMDProfessional Counselor

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X LPC.0011233 CO Yes

Addresses

Primary practice location

1515 Diamond Wall Dr
Berthoud, CO 80513-8449

Mailing address

1515 Diamond Wall Dr
Berthoud, CO 80513-8449
Phone (970) 460-8477

Other identifiers

IdentifierTypeStateIssuer
75248OtherMTBLUE CROSS BLUE SHIELD

Other providers in Berthoud, CO

All providers in Berthoud, CO · Professional Counselor in Colorado

Sources for this page

Verify at the official NPI Registry.