Provider Demographics
NPI:1538760426
Name:SEBY, SANDRA JOYCE (LAC)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:JOYCE
Last Name:SEBY
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1338 W FOREST MEADOWS ST STE 140
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-7226
Mailing Address - Country:US
Mailing Address - Phone:928-212-8621
Mailing Address - Fax:
Practice Address - Street 1:1338 W FOREST MEADOWS ST STE 140
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-7226
Practice Address - Country:US
Practice Address - Phone:928-212-8621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-05
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
AZPENDING101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health