Provider Demographics
NPI:1942505748
Name:SANDERS, LORI SUZANNE (LMFT)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:SUZANNE
Last Name:SANDERS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:SUZANNE
Other - Last Name:MASTERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 422
Mailing Address - Street 2:
Mailing Address - City:HOPE
Mailing Address - State:ID
Mailing Address - Zip Code:83836-0422
Mailing Address - Country:US
Mailing Address - Phone:253-381-4607
Mailing Address - Fax:
Practice Address - Street 1:301 N 1ST AVE STE 203
Practice Address - Street 2:
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-1458
Practice Address - Country:US
Practice Address - Phone:253-381-4607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-26
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF60330019101Y00000X, 101YM0800X, 101YP2500X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional