Provider Demographics
NPI:1831614536
Name:SANDERS, ELLEN ELAINE (MA, LPC)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:ELAINE
Last Name:SANDERS
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 138
Mailing Address - Street 2:
Mailing Address - City:CORSICANA
Mailing Address - State:TX
Mailing Address - Zip Code:75151-0138
Mailing Address - Country:US
Mailing Address - Phone:903-851-4727
Mailing Address - Fax:
Practice Address - Street 1:950 N 4TH ST
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-5436
Practice Address - Country:US
Practice Address - Phone:903-757-1106
Practice Address - Fax:903-757-6076
Is Sole Proprietor?:No
Enumeration Date:2017-08-03
Last Update Date:2017-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX74968101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional