Provider Demographics
NPI:1801991328
Name:SANDS, MARY ANN (LSCSW)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:ANN
Last Name:SANDS
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4220 NW HUXMAN RD
Mailing Address - Street 2:
Mailing Address - City:SILVER LAKE
Mailing Address - State:KS
Mailing Address - Zip Code:66539-9482
Mailing Address - Country:US
Mailing Address - Phone:785-582-5179
Mailing Address - Fax:
Practice Address - Street 1:4220 NW HUXMAN RD
Practice Address - Street 2:
Practice Address - City:SILVER LAKE
Practice Address - State:KS
Practice Address - Zip Code:66539-9482
Practice Address - Country:US
Practice Address - Phone:785-582-5179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1664101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS0000070928OtherBLUECROSS/BLUE SHIELD OF