Healthcare Provider Details

I. General information

NPI: 1043404262
Provider Name (Legal Business Name): JOHN D SANDERS LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2007
Last Update Date: 08/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24401 W MACARTHUR RD
GODDARD KS
67052-8713
US

IV. Provider business mailing address

960 N WILBUR LN
WICHITA KS
67212-3168
US

V. Phone/Fax

Practice location:
  • Phone: 316-794-2760
  • Fax: 316-794-2773
Mailing address:
  • Phone: 316-734-4904
  • Fax: 316-794-2773

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT 538
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License NumberLMFT 538
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: