=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861327090
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TORRENCE SANDERS SST, QMHP
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/17/2026
-----------------------------------------------------
Last Update Date | 06/17/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 540 JENNER DR
-----------------------------------------------------
City | ALLEGAN
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49010-1517
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 269-673-6617
-----------------------------------------------------
Fax | 269-673-2738
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 68304 COUNTY ROAD 380 LOT 30
-----------------------------------------------------
City | SOUTH HAVEN
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49090-9727
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 269-673-6617
-----------------------------------------------------
Fax | 269-673-2738
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171M00000X
-----------------------------------------------------
Taxonomy Name | Case Manager/Care Coordinator
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------