MEDICARE: SHELLY D SANDERS LCSW, LLC

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
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1487503850
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHELLY D SANDERS LCSW, LLC

Provider Business Mailing Address
First Line	:	2454 W GRENOBLE LN
Second Line	:
City	:	COEUR D ALENE
State	:	ID
Zip	:	83815-0481
Country	:	US
Telephone Number	:	208-964-2113
Fax Number	:	208-964-2113

Provider Business Practice Location Address
First Line	:	2454 W GRENOBLE LN
Second Line	:
City	:	COEUR D ALENE
State	:	ID
Zip	:	83815-0481
Country	:	US
Telephone Number	:	208-964-2113
Fax Number	:	208-964-2113

Authorized Official
Title or Position	:	OWNER, LCSW
Name	:	SHELLY D SANDERS
Credential	:	SANDERS
Telephone Number	:	208-964-2113

Provider Enumeration Date	:	01/27/2026
Last Update Date	:	01/27/2026

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