Provider Demographics
NPI:1710775721
Name:FORD-SANDERS, STEPHANIE MAY (MSLM, ACLC)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:MAY
Last Name:FORD-SANDERS
Suffix:
Gender:F
Credentials:MSLM, ACLC
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:ACKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 897
Mailing Address - Street 2:
Mailing Address - City:SUPERIOR
Mailing Address - State:MT
Mailing Address - Zip Code:59872-0897
Mailing Address - Country:US
Mailing Address - Phone:805-284-3329
Mailing Address - Fax:
Practice Address - Street 1:304 4TH AVE E
Practice Address - Street 2:
Practice Address - City:SUPERIOR
Practice Address - State:MT
Practice Address - Zip Code:59872-3075
Practice Address - Country:US
Practice Address - Phone:805-284-3329
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-29
Last Update Date:2025-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-ACLC-LIC-79267101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)