Individual provider Active NPI

Dianna Lynn Sandoval, LPC, LAC

  • Counselor
  • Brighton, CO
National Provider Identifier
1760653554
Registry record updated Feb 14, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
CounselorTaxonomy code 101Y00000X
License
3395 Issued in CO
Practice address
1401 E Bridge St
Brighton, CO 80601-1950
Phone
(303) 359-1352
Fax
(303) 835-2534
NPI assigned
Mar 19, 2008
Last updated
Feb 14, 2020By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 14, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X 3395 CO
Counselor 101Y00000X 3395 CO Primary

Addresses

Primary practice location

1401 E Bridge St
Brighton, CO 80601-1950

Mailing address

1401 E Bridge St
Brighton, CO 80601-1950
Phone (303) 359-1352

Other practice location 1

2002B W 120th Ave # 1
Northglenn, CO 80234-2421
Phone (303) 280-2011

Medicare participation

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

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
3395COMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Tandem Wellness Center, LLC Addiction (Substance Use Disorder) CurrentSince Mar 1, 2020 Accepting new patients

Locations

1401 E Bridge St
Brighton, CO 80601
Phone (303) 359-1352

2002 W 120th Ave
Ste B
Northglenn, CO 80234
Phone (303) 280-2011

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1205884800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1581638400000",
    "number": "1760653554",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1401 E BRIDGE ST",
            "city": "BRIGHTON",
            "state": "CO",
            "postal_code": "806011950",
            "telephone_number": "303-359-1352",
            "fax_number": "303-835-2534"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1401 E BRIDGE ST",
            "city": "BRIGHTON",
            "state": "CO",
            "postal_code": "806011950",
            "telephone_number": "303-359-1352",
            "fax_number": "303-835-2534"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2002B W 120th Ave # 1",
            "address_purpose": "LOCATION",
            "city": "Northglenn",
            "state": "CO",
            "postal_code": "802342421",
            "country_code": "US",
            "telephone_number": "303-280-2011",
            "fax_number": "303-920-1296",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SANDOVAL",
        "first_name": "DIANNA",
        "middle_name": "LYNN",
        "credential": "LPC, LAC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-03-19",
        "last_updated": "2020-02-14",
        "certification_date": "2020-02-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "CO",
            "license": "3395",
            "primary": false
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "CO",
            "license": "3395",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brighton, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.