Provider Demographics
NPI:1821286428
Name:SANDERS PSYCHOLOGICAL SERVICES, INC.
Entity Type:Organization
Organization Name:SANDERS PSYCHOLOGICAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:SANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:417-739-3325
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 STE 2
Practice Address - Street 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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003015983103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty