Provider Demographics
NPI:1205658267
Name:SAUNDERS, CHARLES
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:SAUNDERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:CHARLIE
Other - Middle Name:
Other - Last Name:SAUNDERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:9105 NORTHPARK DR
Mailing Address - Street 2:
Mailing Address - City:JOHNSTON
Mailing Address - State:IA
Mailing Address - Zip Code:50131-4807
Mailing Address - Country:US
Mailing Address - Phone:515-984-0225
Mailing Address - Fax:515-984-0226
Practice Address - Street 1:9105 NORTHPARK DR
Practice Address - Street 2:
Practice Address - City:JOHNSTON
Practice Address - State:IA
Practice Address - Zip Code:50131-4807
Practice Address - Country:US
Practice Address - Phone:515-984-0225
Practice Address - Fax:515-984-0226
Is Sole Proprietor?:No
Enumeration Date:2024-10-30
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA115272101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health