Provider Demographics
NPI:1306086459
Name:BORNE TUSTIN, SANDRA L (LPC)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:L
Last Name:BORNE TUSTIN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:L
Other - Last Name:BOURNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:PO BOX 179
Mailing Address - Street 2:
Mailing Address - City:STIGLER
Mailing Address - State:OK
Mailing Address - Zip Code:74462-0179
Mailing Address - Country:US
Mailing Address - Phone:918-967-3368
Mailing Address - Fax:918-967-4582
Practice Address - Street 1:1505 E MAIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:STIGLER
Practice Address - State:OK
Practice Address - Zip Code:74462-2804
Practice Address - Country:US
Practice Address - Phone:918-967-4560
Practice Address - Fax:918-967-4582
Is Sole Proprietor?:No
Enumeration Date:2009-03-03
Last Update Date:2009-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional