Provider Demographics
NPI:1043320153
Name:SANDERS, RICK A (M ED LPC LCDC)
Entity Type:Individual
Prefix:
First Name:RICK
Middle Name:A
Last Name:SANDERS
Suffix:
Gender:M
Credentials:M ED LPC LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4601 BUFFALO GAP RD
Mailing Address - Street 2:SUITE A1
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79606-3361
Mailing Address - Country:US
Mailing Address - Phone:325-692-1531
Mailing Address - Fax:325-701-9944
Practice Address - Street 1:4601 BUFFALO GAP RD
Practice Address - Street 2:SUITE A1
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-3361
Practice Address - Country:US
Practice Address - Phone:325-692-1531
Practice Address - Fax:325-701-9944
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6579101YA0400X
TX13121101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX027984601Medicaid
TX3810LCOtherBC