Provider Demographics
NPI:1760569362
Name:SANDERS, KEVIN S (PSYD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:S
Last Name:SANDERS
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 85
Mailing Address - Street 2:
Mailing Address - City:KIMBERLING CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65686-0085
Mailing Address - Country:US
Mailing Address - Phone:417-739-3325
Mailing Address - Fax:417-739-3326
Practice Address - Street 1:15060 STATE HIGHWAY 13
Practice Address - Street 2:SUITE 2
Practice Address - City:REEDS SPRING
Practice Address - State:MO
Practice Address - Zip Code:65737-8652
Practice Address - Country:US
Practice Address - Phone:417-739-3325
Practice Address - Fax:417-739-3326
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR007470103T00000X
MO2003015983103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical