Provider Demographics
NPI:1437250511
Name:SANDERSON, URSULA R (PSYD)
Entity Type:Individual
Prefix:DR
First Name:URSULA
Middle Name:R
Last Name:SANDERSON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11006 WHISPER RIDGE ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-3613
Mailing Address - Country:US
Mailing Address - Phone:210-321-2703
Mailing Address - Fax:210-321-2720
Practice Address - Street 1:4455 HORIZON HILL BLVD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-2258
Practice Address - Country:US
Practice Address - Phone:210-317-6077
Practice Address - Fax:210-321-2720
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24436103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical