Liza Sanderson
Individual provider Active NPI Professional Counselor · Kamas, UT
NPI 1447584511 · NPPES record last updated Mar 17, 2018
Key facts
- NPI
- 1447584511
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- 435 (WY)
- Practice address
- 228 W 200 S Ste 2E
Kamas, UT 84036-9010 - Phone
- (801) 360-6955
- NPI assigned
- Sep 22, 2009
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 435 | WY | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Expansive Horizons Counseling & Psychological Services, LLC | Mental Health | Past | Accepting new patients |
| LS Counseling | Counselor | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | 435 | WY | |
| Mental Health Counselor | 101YM0800X | 435 | WY | |
| Professional Counselor | 101YP2500X | 1149 | WY | |
| School Counselor | 101YS0200X | 435 | WY | |
| School Psychologist | 103TS0200X | 435 | WY | |
| Case Management Agency | 251B00000X | 435 | WY | |
| Developmentally Disabled Services Day Training Agency | 251C00000X | 435 | WY | |
| Professional Counselor | 101YP2500X | 435 | WY | Yes |
Addresses
Primary practice location
228 W 200 S Ste 2E
Kamas, UT 84036-9010
Mailing address
596 Ash CT
Kamas, UT 84036-9275
Phone (435) 640-3138
Other practice location 1
1800 Edinburgh St
Rawlins, WY 82301-4506
Phone (307) 324-8820
Other practice location 2
150 N Main St Ste 206
Heber City, UT 84032-1671
Phone (801) 360-6955
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 128433900 | Medicaid | WY |
Other providers in Kamas, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 17, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.