Provider Demographics
NPI:1417553207
Name:SANNER, DEAN M (MFT)
Entity Type:Individual
Prefix:
First Name:DEAN
Middle Name:M
Last Name:SANNER
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4310 LOSEE RD STE 7
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89030-3379
Mailing Address - Country:US
Mailing Address - Phone:702-259-8400
Mailing Address - Fax:
Practice Address - Street 1:4310 LOSEE RD STE 7
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89030-3379
Practice Address - Country:US
Practice Address - Phone:702-259-8400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-08
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV0562106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist