Clifford Dwain Sanders, LPC/LADC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

2874 Issued in OK

Practice address

214 E Oak Ave
Seminole, OK 74868-3442

Phone

(405) 382-1112

NPI assigned

Jan 3, 2013

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Tri-City Substance Abuse Center, Inc.

  • Addiction (Substance Use Disorder) Counselor
  • Seminole, OK
  • NPI 1639294044
  NPD (past)
• Tricity Substance Abuse Center

  • Addiction (Substance Use Disorder) Counselor
  • Seminole, OK
  • NPI 1396962544
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1357171200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1411084800000",
    "number": "1053658534",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24198 BRANGUS RD",
            "city": "TECUMSEH",
            "state": "OK",
            "postal_code": "748737520",
            "telephone_number": "405-598-1761"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "214 E OAK AVE",
            "city": "SEMINOLE",
            "state": "OK",
            "postal_code": "748683442",
            "telephone_number": "405-382-1112"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SANDERS",
        "first_name": "CLIFFORD",
        "middle_name": "DWAIN",
        "name_prefix": "Mr.",
        "credential": "LPC/LADC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-01-03",
        "last_updated": "2014-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OK",
            "license": "798",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OK",
            "license": "2874",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Whitney Alyse Robertson, APRN
• Rocky Mountain Holdings LLC
• Kelli Ann Rollins, ARNP
• Ralph Roy, PHARMD
• Saint Medical Group, LLC
• Semdrug, LLC
• Seminole Clinic PLLC
• Seminole Family Dentistry PLLC
• Seminole Health Care LLC
• Seminole Health Center LLC

• Mental Health Counselor in Seminole, OK
• Providers in Seminole, OK by specialty
• Mental Health Counselor in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.