Provider Demographics
NPI:1912386897
Name:SANDERS, LORA D (LMFT # 125168)
Entity Type:Individual
Prefix:MRS
First Name:LORA
Middle Name:D
Last Name:SANDERS
Suffix:
Gender:F
Credentials:LMFT # 125168
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8910 CLAIREMONT MESA BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1104
Mailing Address - Country:US
Mailing Address - Phone:858-514-5144
Mailing Address - Fax:858-514-5195
Practice Address - Street 1:8910 CLAIREMONT MESA BLVD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1104
Practice Address - Country:US
Practice Address - Phone:858-514-5144
Practice Address - Fax:858-514-5195
Is Sole Proprietor?:No
Enumeration Date:2015-05-25
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390200000X
CA125168106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program