Doctor Name: | MR. JULIO SANDOVAL |
NPI Number: | 1720497555 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LPC |
License Number: | |
Business Practice Address: | 333 N La Grange Rd Suite 1 La Grange Park, IL - 605265646 |
Business Phone Number: | 7089953644 |
Business Fax Number: | |
Mailing Address: | 8311 W. Roosevelt Rd, FOREST PARK |
State: | IL |
Postal Code: | 60130 |
Phone Number: | 7087717000 |
Fax Number: | |
NPI Enumeration Date: | 08/06/2014 |
NPI Last Update Date: | 03/16/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |