Provider Demographics
NPI:1285964882
Name:SANDOVAL, ERIN LEVERENZ (PHD)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:LEVERENZ
Last Name:SANDOVAL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4603 PARK RDG
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-5852
Mailing Address - Country:US
Mailing Address - Phone:979-777-7904
Mailing Address - Fax:979-774-0316
Practice Address - Street 1:2554 E VILLA MARIA RD
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-2037
Practice Address - Country:US
Practice Address - Phone:979-777-7904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-04
Last Update Date:2010-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34241103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist