Provider Demographics
NPI:1013072479
Name:SANDERS, CHERYL LYNN (MC, LPC)
Entity Type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:LYNN
Last Name:SANDERS
Suffix:
Gender:F
Credentials:MC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1718 S LONGMORE UNIT 40
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-5768
Mailing Address - Country:US
Mailing Address - Phone:480-775-6444
Mailing Address - Fax:
Practice Address - Street 1:1232 E BROADWAY RD
Practice Address - Street 2:SUITE #120
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-1511
Practice Address - Country:US
Practice Address - Phone:480-784-1514
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-11167101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional