Mary Louise Sanders, PH.D.,

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

20040682A Issued in IN

Practice address

9102 N Meridian St Ste 400
Indianapolis, IN 46260

Phone

(317) 574-1785

Fax

(317) 574-1786

NPI assigned

Jul 20, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 5

Other names 1

• Mary L Sanders Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

Practice roles

Locations

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.

• Community Psychological Consultants

  • Clinical Psychologist
  • Indianapolis, IN
  • NPI 1619184678
  NPD Authorized official

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

{
    "created_epoch": "1153353600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1528156800000",
    "number": "1326068495",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9102 N MERIDIAN ST STE 400",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462601809",
            "telephone_number": "317-574-1785",
            "fax_number": "317-574-1786"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9102 N MERIDIAN ST STE 400",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "46260",
            "telephone_number": "317-574-1785",
            "fax_number": "317-574-1786"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SANDERS",
        "first_name": "MARY",
        "middle_name": "LOUISE",
        "name_prefix": "Dr.",
        "credential": "PH.D.,",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-07-20",
        "last_updated": "2018-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IN",
            "license": "20040682A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1073067526",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1619184678",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1326068495",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1841498854",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1487700639",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARY",
            "last_name": "SANDERS",
            "middle_name": "L",
            "credential": "PH.D., HSPP",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Jerico Sanders
• Jordan Sanders
• Kala Sanders, PHARMD
• Kamiyah Sanders
• Marie Sanders, MSW
• Michael Sanders
• Quentessa Anisha Sanders, CPSP
• Rebecca Lynn Sanders
• Ryan Sanders
• Shalanda J Sanders

• Clinical Psychologist in Indianapolis, IN
• Providers in Indianapolis, IN by specialty
• Clinical Psychologist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2018; 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.