Healthcare Provider Details

I. General information

NPI: 1275269227
Provider Name (Legal Business Name): JUDY C SANDERS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2022
Last Update Date: 07/30/2022
Certification Date: 07/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2553 BRAINTREE DR
HIGH RIDGE MO
63049-2409
US

IV. Provider business mailing address

10 FENTON PLZ UNIT 9
FENTON MO
63026-9991
US

V. Phone/Fax

Practice location:
  • Phone: 314-660-0769
  • Fax:
Mailing address:
  • Phone: 314-660-0769
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number00250723
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2020009675
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: