=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700927704
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOHN LEE SANDERS PH.D
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/11/2007
-----------------------------------------------------
Last Update Date | 06/02/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 863 BENNETT AVE
-----------------------------------------------------
City | LEXINGTON
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40508-3103
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 859-266-6786
-----------------------------------------------------
Fax | 859-268-0886
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 863 BENNETT AVE
-----------------------------------------------------
City | LEXINGTON
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40508-3103
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 859-266-6786
-----------------------------------------------------
Fax | 859-268-0886
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 914
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------