Provider Demographics
NPI:1194097626
Name:SANDRA L. PARENT, PH.D., LP, PLLC
Entity type:Organization
Organization Name:SANDRA L. PARENT, PH.D., LP, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST/SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:L
Authorized Official - Last Name:PARENT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:313-304-6352
Mailing Address - Street 1:806 OAKWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-2319
Mailing Address - Country:US
Mailing Address - Phone:313-304-6352
Mailing Address - Fax:313-221-9998
Practice Address - Street 1:15460 DANIEL CT
Practice Address - Street 2:
Practice Address - City:ALLEN PARK
Practice Address - State:MI
Practice Address - Zip Code:48101-3306
Practice Address - Country:US
Practice Address - Phone:313-304-6352
Practice Address - Fax:313-221-9998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-30
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301014705103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty