Provider Demographics
NPI:1275269227
Name:SANDERS, JUDY C (LPC)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:C
Last Name:SANDERS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 FENTON PLZ UNIT 9
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63026-9991
Mailing Address - Country:US
Mailing Address - Phone:314-660-0769
Mailing Address - Fax:
Practice Address - Street 1:2553 BRAINTREE DR
Practice Address - Street 2:
Practice Address - City:HIGH RIDGE
Practice Address - State:MO
Practice Address - Zip Code:63049-2409
Practice Address - Country:US
Practice Address - Phone:314-660-0769
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-30
Last Update Date:2022-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO00250723225C00000X
MO2020009675101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor