| Doctor Name: | MS. SANDRA LEE MATTSON EBELTOFT |
| NPI Number: | 1558589234 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | ED.S. |
| License Number: | |
| Business Practice Address: | 12606 E. Main St. Mayer, AZ - 86333 |
| Business Phone Number: | 9286421010 |
| Business Fax Number: | 9286324005 |
| Mailing Address: | 1950 Lazy Meadow Ln, PRESCOTT |
| State: | AZ |
| Postal Code: | 863035044 |
| Phone Number: | 9284450121 |
| Fax Number: | 9285419043 |
| NPI Enumeration Date: | 04/20/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TS0200X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | School |
| Taxonomy Definition: | |