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General NPI Number Information
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NPI Number | 1508270612
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Entity Type | Organization
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Legal Business Name | SANDERS AND ASSOCIATES
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Dates
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Enumeration Date | 06/17/2014
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Last Update Date | 06/17/2014
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Provider Practice Location Address
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Address Line | 863 BENNETT AVE
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City | LEXINGTON
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State | KY
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Zip | 40508-3103
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Country | US
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Telephone | 859-266-6786
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Fax | 859-268-0886
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Provider Business Mailing Address
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Address Line | 863 BENNETT AVE
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City | LEXINGTON
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State | KY
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Zip | 40508-3103
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Country | US
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Telephone | 859-266-6786
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Fax | 859-268-0886
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Authorized Official
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Title or Position | LICENSED PSYCHOLOGIST
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Name | JOHN LEE SANDERS
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Credential | PHD
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Telephone | 859-266-6786
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 1102
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 914
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License Number State | KY
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