Provider Demographics
NPI:1649201203
Name:SANDERS, GERALD HENRY (MFT)
Entity Type:Individual
Prefix:MR
First Name:GERALD
Middle Name:HENRY
Last Name:SANDERS
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 1:25 E FERN AVE
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-6003
Mailing Address - Country:US
Mailing Address - Phone:909-798-2209
Mailing Address - Fax:909-798-0694
Practice Address - Street 1:47 FIRST ST
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-6003
Practice Address - Country:US
Practice Address - Phone:909-798-2209
Practice Address - Fax:909-798-0694
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC12922106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist