Provider Demographics
NPI:1053559146
Name:SANFORD, ERIN L (MA, NCC, LPC-MH)
Entity type:Individual
Prefix:MS
First Name:ERIN
Middle Name:L
Last Name:SANFORD
Suffix:
Gender:F
Credentials:MA, NCC, LPC-MH
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:L
Other - Last Name:WEBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, NCC, LPC-MH
Mailing Address - Street 1:6901 S. LYNCREST PLACE SUITE 105
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108
Mailing Address - Country:US
Mailing Address - Phone:605-335-1516
Mailing Address - Fax:605-731-0896
Practice Address - Street 1:6901 S. LYNCREST PLACE SUITE 105
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108
Practice Address - Country:US
Practice Address - Phone:605-335-1516
Practice Address - Fax:605-731-0896
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-27
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDLPC 7074101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5200020Medicaid