Provider Demographics
NPI:1639404452
Name:SANDERS, JENNIFER MARRS (LPC)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:MARRS
Last Name:SANDERS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5050 WESTGROVE DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75248-6042
Mailing Address - Country:US
Mailing Address - Phone:214-761-3715
Mailing Address - Fax:214-432-3005
Practice Address - Street 1:17400 DALLAS PWKY.
Practice Address - Street 2:SUITE 100
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75287-6042
Practice Address - Country:US
Practice Address - Phone:214-761-3715
Practice Address - Fax:214-432-3005
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-13
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16054101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional