Provider Demographics
NPI:1659450823
Name:SANDERS, TREVA ROSS (LPC)
Entity Type:Individual
Prefix:MRS
First Name:TREVA
Middle Name:ROSS
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 1:703 CALVIN AVERY DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:WEST MEMPHIS
Mailing Address - State:AR
Mailing Address - Zip Code:72301-6501
Mailing Address - Country:US
Mailing Address - Phone:870-732-1878
Mailing Address - Fax:
Practice Address - Street 1:703 CALVIN AVERY DR
Practice Address - Street 2:SUITE B
Practice Address - City:WEST MEMPHIS
Practice Address - State:AR
Practice Address - Zip Code:72301-6501
Practice Address - Country:US
Practice Address - Phone:870-732-1878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA0210071101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health