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General NPI Number Information
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NPI Number | 1255740601
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Entity Type | Organization
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Legal Business Name | MARY E. SANDERS
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Dates
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Enumeration Date | 08/11/2014
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Last Update Date | 03/18/2016
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Provider Practice Location Address
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Address Line | 1000 COUNTY ROAD E W SUITE 142
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City | SHOREVIEW
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State | MN
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Zip | 55126-8054
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Country | US
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Telephone | 651-402-0618
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Fax |
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Provider Business Mailing Address
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Address Line | 1000 COUNTY ROAD E W SUITE 142
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City | SHOREVIEW
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State | MN
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Zip | 55126-8054
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Country | US
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Telephone | 651-402-0618
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Fax |
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Authorized Official
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Title or Position | LIC MARRIAGE AND FAMILY THERAPAPIST
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Name | MS. MARY ELIZABETH SANDERS
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Credential | M.A., LMFT
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Telephone | 651-402-0618
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 1787
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License Number State | MN
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