Active NPI
Judith Ann Sandberg, M.F.T.
- Mental Health Counselor
- Eureka, CA
National Provider Identifier
1528129749
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- MFC34866
- Practice address
- 3009 Hubbard LN
Ste. D
Eureka, CA 95501-4800 - Phone
- (707) 269-0157
- NPI assigned
- Dec 12, 2006
- Last updated
- Jul 8, 2007
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | MFC34866 | CA | Primary |
Addresses
Primary practice location
3009 Hubbard LN
Ste. D
Eureka, CA 95501-4800
Mailing address
176 E 11TH St
Arcata, CA 95521-6067
Phone (707) 826-9213
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 2, 2024 through Jan 2, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MFC34866 | CA | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165881600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1528129749",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "176 E 11TH ST",
"city": "ARCATA",
"state": "CA",
"postal_code": "955216067",
"telephone_number": "707-826-9213"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3009 HUBBARD LN",
"address_2": "STE. D",
"city": "EUREKA",
"state": "CA",
"postal_code": "955014800",
"telephone_number": "707-269-0157"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SANDBERG",
"first_name": "JUDITH",
"middle_name": "ANN",
"name_prefix": "Mrs.",
"credential": "M.F.T.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-12-12",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "CA",
"license": "MFC34866",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Eureka, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.