Provider Demographics
NPI:1619911096
Name:CARTER-SAND, STACEY ANNE (PHD)
Entity type:Individual
Prefix:DR
First Name:STACEY
Middle Name:ANNE
Last Name:CARTER-SAND
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3004 W 121ST TER
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66209-2134
Mailing Address - Country:US
Mailing Address - Phone:913-548-1626
Mailing Address - Fax:913-415-2201
Practice Address - Street 1:10561 BARKLEY ST STE 630
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66212-1880
Practice Address - Country:US
Practice Address - Phone:913-415-2200
Practice Address - Fax:913-415-2201
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLP1341103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSK01E386Medicare ID - Type Unspecified