Provider Demographics
NPI:1417074469
Name:INTERVENTION INSTITUTE
Entity Type:Organization
Organization Name:INTERVENTION INSTITUTE
Other - Org Name:LAURIE A. SANDERS, M.S.
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE AND CLINICAL DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:SANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT, CADCII-CCS,CAS
Authorized Official - Phone:805-375-9100
Mailing Address - Street 1:1125 BUSINESS CENTER CIR
Mailing Address - Street 2:SUITE B
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91320-1184
Mailing Address - Country:US
Mailing Address - Phone:805-375-9100
Mailing Address - Fax:805-375-9920
Practice Address - Street 1:1125 BUSINESS CENTER CIR
Practice Address - Street 2:SUITE B
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91320-1184
Practice Address - Country:US
Practice Address - Phone:805-375-9100
Practice Address - Fax:805-375-9920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA560027AP CERTIFICATI251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA560027APOtherOUT-PT AAOD SVCS CERTIFIC