Provider Demographics
NPI:1861906539
Name:SANDOVAL, OMAR (LPC)
Entity type:Individual
Prefix:
First Name:OMAR
Middle Name:
Last Name:SANDOVAL
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 31ST ST
Mailing Address - Street 2:
Mailing Address - City:HIDALGO
Mailing Address - State:TX
Mailing Address - Zip Code:78557-3621
Mailing Address - Country:US
Mailing Address - Phone:956-320-7809
Mailing Address - Fax:
Practice Address - Street 1:417 31ST ST
Practice Address - Street 2:
Practice Address - City:HIDALGO
Practice Address - State:TX
Practice Address - Zip Code:78557-3621
Practice Address - Country:US
Practice Address - Phone:956-320-7809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-16
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX78354101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty