Individual
SANDRA MAIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMLP
Contact information
Practice address
6610 SE QUAKERVALE RD, RIVERTON, KS 66770-4185
(620) 848-2300
(620) 848-2301
Mailing address
PO BOX 550, RIVERTON, KS 66770-0550
(620) 848-2300
(620) 848-2301
Taxonomy
Speciality
Code
Description
License number
State
103TC1900X
Counseling Psychologist
Primary
1245
KS
Other
Enumeration date
05/07/2012
Last updated
05/07/2012
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