Provider Demographics
NPI:1235921404
Name:SALAS, SANDRA L (LPC)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:L
Last Name:SALAS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2406 EAST AVE
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402-2638
Mailing Address - Country:US
Mailing Address - Phone:708-908-0855
Mailing Address - Fax:
Practice Address - Street 1:3801 S CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:CICERO
Practice Address - State:IL
Practice Address - Zip Code:60804-4398
Practice Address - Country:US
Practice Address - Phone:708-908-0855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-21
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.017698101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health