Active NPI
Stacy Bernard Sanders, PHD, LAC
- Addiction (Substance Use Disorder) Counselor
- Ruston, LA
National Provider Identifier
1053784728
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- LAC-5154
- Practice address
- 206 E Reynolds Dr Ste G2
Ruston, LA 71270-2873 - Phone
- (915) 276-2548
- Fax
- (318) 259-4571
- NPI assigned
- Nov 3, 2015
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 5
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | |||
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | |||
| Mental Health Counselor | 101YM0800X | |||
| Case Manager/Care Coordinator | 171M00000X | |||
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | LAC-5154 | LA | Primary |
Addresses
Primary practice location
206 E Reynolds Dr Ste G2
Ruston, LA 71270-2873
Mailing address
898 Brooks Chapel Rd
Quitman, LA 71268-4670
Phone (915) 276-2548
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LAC-5154 | LA | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1446508800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1708905600000",
"number": "1053784728",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "898 BROOKS CHAPEL RD",
"city": "QUITMAN",
"state": "LA",
"postal_code": "712684670",
"telephone_number": "915-276-2548"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "206 E REYNOLDS DR STE G2",
"city": "RUSTON",
"state": "LA",
"postal_code": "712702873",
"telephone_number": "915-276-2548",
"fax_number": "318-259-4571"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SANDERS",
"first_name": "STACY",
"middle_name": "BERNARD",
"name_prefix": "Dr.",
"credential": "PHD, LAC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-11-03",
"last_updated": "2024-02-26",
"certification_date": "2024-02-26",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": null,
"license": null,
"primary": false
},
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": null,
"license": null,
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": false
},
{
"code": "171M00000X",
"taxonomy_group": "",
"desc": "Case Manager/Care Coordinator",
"state": null,
"license": null,
"primary": false
},
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "LA",
"license": "LAC-5154",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ruston, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.