Basic Information
| Provider Information | |||||||||
| NPI: | 1740674712 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCLEOD | ||||||||
| FirstName: | SANDRA | ||||||||
| MiddleName: | LYNN | ||||||||
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| Mailing Information | |||||||||
| Address1: | THE MARSTON CENTER, 677 WOODLAND SQUARE LOOP SOUTHEAST | ||||||||
| Address2: | SUITE C-5 | ||||||||
| City: | LACEY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3602092422 | ||||||||
| FaxNumber: | 3603528868 | ||||||||
| Practice Location | |||||||||
| Address1: | THE MARSTON CENTER, 677 WOODLAND SQUARE LOOP SE | ||||||||
| Address2: | SUITE C-5 | ||||||||
| City: | LACEY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3602092422 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/26/2015 | ||||||||
| LastUpdateDate: | 08/30/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | LF60867756 | WA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.