Healthcare Provider Details

I. General information

NPI: 1053967737
Provider Name (Legal Business Name): BRICE SANNER LCMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2019
Last Update Date: 04/19/2022
Certification Date: 04/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

149 S ANDOVER RD STE 100
ANDOVER KS
67002-7935
US

IV. Provider business mailing address

PO BOX 626
ANDOVER KS
67002-0626
US

V. Phone/Fax

Practice location:
  • Phone: 316-247-3063
  • Fax: 316-247-6833
Mailing address:
  • Phone: 316-247-3063
  • Fax: 316-247-6833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number3066
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number03105
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: