Provider Demographics
NPI:1912116559
Name:MOLD, SANDRA C (LPC)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:C
Last Name:MOLD
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:917 CAINES HILL RD
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-2303
Mailing Address - Country:US
Mailing Address - Phone:405-341-3554
Mailing Address - Fax:405-341-3511
Practice Address - Street 1:1251 N BROADWAY
Practice Address - Street 2:SUITE C
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-3616
Practice Address - Country:US
Practice Address - Phone:405-341-3554
Practice Address - Fax:405-341-3511
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1497101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional