Provider Demographics
NPI:1982155925
Name:SANDERS, TARYN LOGAN
Entity Type:Individual
Prefix:MISS
First Name:TARYN
Middle Name:LOGAN
Last Name:SANDERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 N 6TH ST STE 2
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-4119
Mailing Address - Country:US
Mailing Address - Phone:318-737-7201
Mailing Address - Fax:318-737-7693
Practice Address - Street 1:403 N 6TH ST STE 2
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-4119
Practice Address - Country:US
Practice Address - Phone:318-737-7201
Practice Address - Fax:318-737-7693
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-14
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA7885101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty