Provider Demographics
NPI:1083017099
Name:SANFORD, JANEL R (LMSW, LMAC)
Entity Type:Individual
Prefix:MRS
First Name:JANEL
Middle Name:R
Last Name:SANFORD
Suffix:
Gender:F
Credentials:LMSW, LMAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 W DOUGLAS AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67202-2904
Mailing Address - Country:US
Mailing Address - Phone:316-759-9136
Mailing Address - Fax:316-500-7862
Practice Address - Street 1:300 W DOUGLAS AVE STE 205
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67202-2904
Practice Address - Country:US
Practice Address - Phone:316-759-9136
Practice Address - Fax:316-500-7862
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-04
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS8527104100000X
KS056541041C0700X
KS150101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201125860AMedicaid
KS13564020OtherCAQH
LA3004627850001Medicaid