Provider Demographics
NPI:1649692229
Name:SANDERS, MICHAEL EUGENE I (LMFT)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:EUGENE
Last Name:SANDERS
Suffix:I
Gender:M
Credentials:LMFT
Other - Prefix:MR
Other - First Name:MIKE
Other - Middle Name:EUGENE
Other - Last Name:SANDERS
Other - Suffix:I
Other - Last Name Type:Other Name
Other - Credentials:LMFT
Mailing Address - Street 1:160 CAPP ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-1210
Mailing Address - Country:US
Mailing Address - Phone:415-621-8054
Mailing Address - Fax:415-621-6209
Practice Address - Street 1:160 CAPP
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-1210
Practice Address - Country:US
Practice Address - Phone:415-621-8054
Practice Address - Fax:415-621-6209
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-15
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT28704101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFHC11429FMedicaid