Provider Demographics
NPI:1043404262
Name:SANDERS, JOHN D (LMFT)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:D
Last Name:SANDERS
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:960 N WILBUR LN
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212-3168
Mailing Address - Country:US
Mailing Address - Phone:316-734-4904
Mailing Address - Fax:316-794-2773
Practice Address - Street 1:24401 W MACARTHUR RD
Practice Address - Street 2:
Practice Address - City:GODDARD
Practice Address - State:KS
Practice Address - Zip Code:67052-8713
Practice Address - Country:US
Practice Address - Phone:316-794-2760
Practice Address - Fax:316-794-2773
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-30
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLMFT 538106H00000X, 323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist