Healthcare Provider Details

I. General information

NPI: 1124643515
Provider Name (Legal Business Name): CRYSTAL LYNN SANDERS CACD-I
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2020
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2050 N HIGHWAY 160 SUITE 600
PAHRUMP NV
89060-4613
US

IV. Provider business mailing address

1040 JUBILEE CT APT 2
PAHRUMP NV
89048-3304
US

V. Phone/Fax

Practice location:
  • Phone: 702-600-2527
  • Fax:
Mailing address:
  • Phone: 702-600-2527
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number08279-I
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: