Provider Demographics
NPI:1972587087
Name:BERG, SANDRA K (LPC LCPC)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:K
Last Name:BERG
Suffix:
Gender:F
Credentials:LPC LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 S BROADWAY ST
Mailing Address - Street 2:SUITE 410
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67202-4228
Mailing Address - Country:US
Mailing Address - Phone:316-350-7813
Mailing Address - Fax:
Practice Address - Street 1:221 S BROADWAY ST
Practice Address - Street 2:SUITE 410
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67202-4228
Practice Address - Country:US
Practice Address - Phone:316-350-7813
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-01
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS824101YP2500X
KS329101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional