Provider Demographics
NPI:1427297720
Name:BRINDAMOUR, SANDRA LEE (PSYD)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:LEE
Last Name:BRINDAMOUR
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3018 OLD MINDEN RD
Mailing Address - Street 2:SUITE 1111
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71112-2476
Mailing Address - Country:US
Mailing Address - Phone:318-741-7485
Mailing Address - Fax:
Practice Address - Street 1:3018 OLD MINDEN RD
Practice Address - Street 2:SUITE 1111
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71112-2476
Practice Address - Country:US
Practice Address - Phone:318-741-7485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-10
Last Update Date:2009-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1036103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical