Provider Demographics
NPI:1326068495
Name:SANDERS, MARY LOUISE (PHD,)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:LOUISE
Last Name:SANDERS
Suffix:
Gender:F
Credentials:PHD,
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:L
Other - Last Name:SANDERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD, HSPP
Mailing Address - Street 1:9102 N MERIDIAN ST STE 400
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-1809
Mailing Address - Country:US
Mailing Address - Phone:317-574-1785
Mailing Address - Fax:317-574-1786
Practice Address - Street 1:9102 N MERIDIAN ST STE 400
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260
Practice Address - Country:US
Practice Address - Phone:317-574-1785
Practice Address - Fax:317-574-1786
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20040682A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1073067526Medicaid
IN1619184678Medicaid
IN1326068495Medicaid
IN1841498854Medicaid
IN1487700639Medicaid