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NPI Code Detail

MEDICARE: JAMES MICHAEL SANDERS LCSW

MEDICARE: JAMES MICHAEL SANDERS LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker103271TX

General Provider Information

NPI Number : 1386472801
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAMES MICHAEL SANDERS LCSW
Provider Business Mailing Address
First Line : 101 NEW YORK AVE
Second Line :
City : FORT WORTH
State : TX
Zip : 76104-1558
Country : US
Telephone Number : 469-924-4400
Fax Number : 817-730-0822
Provider Business Practice Location Address
First Line : 101 NEW YORK AVE
Second Line :
City : FORT WORTH
State : TX
Zip : 76104-1558
Country : US
Telephone Number : 469-924-4400
Fax Number : 817-730-0822
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/25/2024
Last Update Date : 07/25/2024

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