Provider Demographics
NPI:1609280437
Name:SANDERS, JEFFREY (LPCC)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:SANDERS
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 PINE AVE SE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44483-6524
Mailing Address - Country:US
Mailing Address - Phone:330-393-0598
Mailing Address - Fax:330-393-0700
Practice Address - Street 1:820 PINE AVE SE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44483-6524
Practice Address - Country:US
Practice Address - Phone:330-393-0598
Practice Address - Fax:330-393-0700
Is Sole Proprietor?:No
Enumeration Date:2014-06-19
Last Update Date:2014-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0008367101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0803312Medicaid
OH0803312Medicaid