Healthcare Provider Details

I. General information

NPI: 1649147901
Provider Name (Legal Business Name): BIANCA RENEE SANDERS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2025
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2730 E CHESTNUT EXPY
SPRINGFIELD MO
65802-2555
US

IV. Provider business mailing address

2160 HIGHWAY Z
HALF WAY MO
65663-9243
US

V. Phone/Fax

Practice location:
  • Phone: 417-848-1756
  • Fax:
Mailing address:
  • Phone: 417-848-1756
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2025045731
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: