Basic Information
| Provider Information | |||||||||
| NPI: | 1205224375 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WORKMAN | ||||||||
| FirstName: | SANDRA | ||||||||
| MiddleName: | |||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 125 CRESTRIDGE ST | ||||||||
| Address2: | |||||||||
| City: | FORT COLLINS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805253934 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9704949761 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 149 W OAK ST | ||||||||
| Address2: | |||||||||
| City: | FORT COLLINS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805242875 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9702143221 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/24/2014 | ||||||||
| LastUpdateDate: | 07/28/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/28/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | 0107397 | CO | N | Behavioral Health & Social Service Providers | Counselor | 103K00000X | N | Behavioral Health & Social Service Providers | Behavioral Analyst | 101YM0800X | 0015661 | CO | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.