1255710521 NPI number — DR. ERICA JANAE TAYLOR SANDERS DSW, LCSW-S

Table of content: DR. ERICA JANAE TAYLOR SANDERS DSW, LCSW-S (NPI 1255710521)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255710521 NPI number — DR. ERICA JANAE TAYLOR SANDERS DSW, LCSW-S

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SANDERS
Provider First Name:
ERICA
Provider Middle Name:
JANAE TAYLOR
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DSW, LCSW-S
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TAYLOR
Provider Other First Name:
ERICA
Provider Other Middle Name:
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1255710521
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/29/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1692
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RED OAK
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75154-1564
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-932-5231
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2909 N BUCKNER BLVD
Provider Second Line Business Practice Location Address:
STE 501
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75228-4861
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-932-5231
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/20/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171M00000X , with the licence number:  54589 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 104100000X , with the licence number: 54589 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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