Provider Demographics
NPI:1861868218
Name:SANDOVAL, DENISE (MED, LCPC)
Entity type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:
Last Name:SANDOVAL
Suffix:
Gender:F
Credentials:MED, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4106 GAGE AVE
Mailing Address - Street 2:
Mailing Address - City:LYONS
Mailing Address - State:IL
Mailing Address - Zip Code:60534-1408
Mailing Address - Country:US
Mailing Address - Phone:708-955-1522
Mailing Address - Fax:
Practice Address - Street 1:21 S LA GRANGE RD STE 200
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:IL
Practice Address - Zip Code:60525-2479
Practice Address - Country:US
Practice Address - Phone:708-955-1522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-19
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180011932101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional