1821286428 NPI number — SANDERS PSYCHOLOGICAL SERVICES, INC.

Table of content: (NPI 1821286428)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821286428 NPI number — SANDERS PSYCHOLOGICAL SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SANDERS PSYCHOLOGICAL SERVICES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1821286428
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 85
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KIMBERLING CITY
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65686-0085
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
417-739-3325
Provider Business Mailing Address Fax Number:
417-739-3326

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15060 STATE HIGHWAY 13 STE 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
REEDS SPRING
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65737-8652
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-739-3325
Provider Business Practice Location Address Fax Number:
417-739-3326
Provider Enumeration Date:
10/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SANDERS
Authorized Official First Name:
KEVIN
Authorized Official Middle Name:
SCOTT
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
417-739-3325

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  2003015983 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com