Healthcare Provider Details

I. General information

NPI: 1437821501
Provider Name (Legal Business Name): EMILY SANDERSON COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2021
Last Update Date: 09/28/2021
Certification Date: 09/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 OFFICE PARK DR STE 312
MOUNTAIN BRK AL
35223-2456
US

IV. Provider business mailing address

200 OFFICE PARK DR STE 312
MOUNTAIN BRK AL
35223-2456
US

V. Phone/Fax

Practice location:
  • Phone: 205-202-9474
  • Fax:
Mailing address:
  • Phone: 205-202-9474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MISS EMILY ELIZABETH SANDERSON
Title or Position: COUNSELOR
Credential: LPC
Phone: 205-410-6020