Provider Demographics
NPI:1649494493
Name:RUSH-SANDBERG, LEEANN MICHELLE (MFT)
Entity type:Individual
Prefix:MRS
First Name:LEEANN
Middle Name:MICHELLE
Last Name:RUSH-SANDBERG
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 S MAIN ST STE 210B
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-2354
Mailing Address - Country:US
Mailing Address - Phone:831-796-1532
Mailing Address - Fax:831-757-3135
Practice Address - Street 1:1000 S MAIN ST STE 210B
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-2354
Practice Address - Country:US
Practice Address - Phone:831-796-1532
Practice Address - Fax:831-757-3135
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC#41835106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA41157OtherUNICARE BILLING CODE