Provider Demographics
NPI:1184924664
Name:SANDERS, QUINCY (MFT)
Entity type:Individual
Prefix:
First Name:QUINCY
Middle Name:
Last Name:SANDERS
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6051 DAWN VIEW LN
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-1675
Mailing Address - Country:US
Mailing Address - Phone:702-418-0944
Mailing Address - Fax:702-418-1944
Practice Address - Street 1:9811 W CHARLESTON BLVD
Practice Address - Street 2:STE 2538
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117
Practice Address - Country:US
Practice Address - Phone:702-418-0944
Practice Address - Fax:702-418-1944
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-29
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1710295860Medicaid
NV9005056211Medicaid