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General NPI Number Information
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NPI Number | 1578795100
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Entity Type | Individual
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Provider Name | PEARL RHONNE SANDERSON PH.D.
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Gender | Male
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Dates
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Enumeration Date | 08/15/2009
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Last Update Date | 01/07/2010
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Provider Practice Location Address
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Address Line | 3840 HULEN ST SUITE 602
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City | FORT WORTH
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State | TX
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Zip | 76107-7277
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Country | US
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Telephone | 817-729-3034
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Fax | 817-735-4688
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Provider Business Mailing Address
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Address Line | 4704 PINE RIDGE LN
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City | FORT WORTH
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State | TX
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Zip | 76123-4638
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Country | US
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Telephone | 817-729-3034
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Fax | 817-263-4337
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 005045-005671
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MT 681
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License Number State | FL
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