Provider Demographics
NPI:1588098156
Name:GAYLORD, SANDY LEE (LPC-S)
Entity type:Individual
Prefix:
First Name:SANDY
Middle Name:LEE
Last Name:GAYLORD
Suffix:
Gender:F
Credentials:LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5641 SMU BLVD.
Mailing Address - Street 2:SUITE 105
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75206
Mailing Address - Country:US
Mailing Address - Phone:469-232-9596
Mailing Address - Fax:469-232-9597
Practice Address - Street 1:5641 SMU BLVD.
Practice Address - Street 2:SUITE 105
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75206
Practice Address - Country:US
Practice Address - Phone:469-232-9596
Practice Address - Fax:469-232-9597
Is Sole Proprietor?:No
Enumeration Date:2013-08-30
Last Update Date:2013-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15198101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional