Healthcare Provider Details

I. General information

NPI: 1043320153
Provider Name (Legal Business Name): RICK A SANDERS M ED LPC LCDC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 02/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4601 BUFFALO GAP RD SUITE A1
ABILENE TX
79606-3361
US

IV. Provider business mailing address

4601 BUFFALO GAP RD SUITE A1
ABILENE TX
79606-3361
US

V. Phone/Fax

Practice location:
  • Phone: 325-692-1531
  • Fax: 325-701-9944
Mailing address:
  • Phone: 325-692-1531
  • Fax: 325-701-9944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number6579
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number13121
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: