Individual
BRIAN E SANDOVAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSYD
Contact information
Practice address
10330 SE 32ND AVE, SUITE 205, MILWAUKIE, OR 97222-6587
(503) 513-8950
(503) 513-8951
Mailing address
PO BOX 190, TOPPENISH, WA 98948-0190
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
103TC0700X
Clinical Psychologist
Primary
2153
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500640102
—
OR
Enumeration date
09/29/2009
Last updated
04/12/2018
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