Provider Demographics
NPI:1578795100
Name:SANDERSON, PEARL RHONNE (PHD)
Entity Type:Individual
Prefix:DR
First Name:PEARL
Middle Name:RHONNE
Last Name:SANDERSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:P.
Other - Middle Name:RHONNE
Other - Last Name:SANDERSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:4704 PINE RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76123-4638
Mailing Address - Country:US
Mailing Address - Phone:817-729-3034
Mailing Address - Fax:817-263-4337
Practice Address - Street 1:3840 HULEN ST
Practice Address - Street 2:SUITE 602
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-7277
Practice Address - Country:US
Practice Address - Phone:817-729-3034
Practice Address - Fax:817-735-4688
Is Sole Proprietor?:No
Enumeration Date:2009-08-15
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX005045-005671106H00000X
FLMT 681106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX005045-005671OtherBOARD OF MARRIAGE AND FAMILY THERAPY
FLMT 681OtherBOARD OF CLINICAL SOCIAL WORK, MARRIAGE & FAMILY THERAPY, AND MENTAL HEALTH COUN