Healthcare Provider Details

I. General information

NPI: 1609280437
Provider Name (Legal Business Name): JEFFREY SANDERS LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2014
Last Update Date: 06/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 PINE AVE SE
WARREN OH
44483-6524
US

IV. Provider business mailing address

820 PINE AVE SE
WARREN OH
44483-6524
US

V. Phone/Fax

Practice location:
  • Phone: 330-393-0598
  • Fax: 330-393-0700
Mailing address:
  • Phone: 330-393-0598
  • Fax: 330-393-0700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE0008367
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: