Healthcare Provider Details

I. General information

NPI: 1437250511
Provider Name (Legal Business Name): URSULA R SANDERSON PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4455 HORIZON HILL BLVD
SAN ANTONIO TX
78229-2258
US

IV. Provider business mailing address

11006 WHISPER RIDGE ST
SAN ANTONIO TX
78230-3613
US

V. Phone/Fax

Practice location:
  • Phone: 210-317-6077
  • Fax: 210-321-2720
Mailing address:
  • Phone: 210-321-2703
  • Fax: 210-321-2720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number24436
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: