MEDICARE: SANDERS PSYCHOLOGICAL SERVICES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	2003015983	MO

General Provider Information

NPI Number	:	1821286428
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SANDERS PSYCHOLOGICAL SERVICES, INC.

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

Provider Business Practice Location Address
First Line	:	15060 STATE HIGHWAY 13 STE 2
Second Line	:
City	:	REEDS SPRING
State	:	MO
Zip	:	65737-8652
Country	:	US
Telephone Number	:	417-739-3325
Fax Number	:	417-739-3326

Authorized Official
Title or Position	:	PRESIDENT
Name	:	KEVIN SCOTT SANDERS
Credential	:	PSY.D.
Telephone Number	:	417-739-3325

Provider Enumeration Date	:	10/09/2007
Last Update Date	:	10/09/2007

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