Provider Demographics
NPI:1104499599
Name:WEBBER, SANDY (MA, LPC-S)
Entity type:Individual
Prefix:
First Name:SANDY
Middle Name:
Last Name:WEBBER
Suffix:
Gender:F
Credentials:MA, LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1262 ELMBROOK DR
Mailing Address - Street 2:
Mailing Address - City:KENNEDALE
Mailing Address - State:TX
Mailing Address - Zip Code:76060-6039
Mailing Address - Country:US
Mailing Address - Phone:214-566-9607
Mailing Address - Fax:
Practice Address - Street 1:1262 ELMBROOK DR
Practice Address - Street 2:
Practice Address - City:KENNEDALE
Practice Address - State:TX
Practice Address - Zip Code:76060-6039
Practice Address - Country:US
Practice Address - Phone:214-566-9607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-22
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX70358101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health