Healthcare Provider Details

I. General information

NPI: 1063332609
Provider Name (Legal Business Name): STANLEY STEPHEN SANDERS II LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: S STEPHEN SANDERS LMSW

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 MIRACLE LN
GARDEN VALLEY ID
83622-1044
US

IV. Provider business mailing address

5131 NE 94TH AVE
VANCOUVER WA
98662-6183
US

V. Phone/Fax

Practice location:
  • Phone: 208-462-0077
  • Fax: 208-462-3209
Mailing address:
  • Phone: 208-462-0077
  • Fax: 208-462-3209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number7381911
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: