Provider Demographics
NPI:1104231463
Name:SANDERS, LAURA RAE (PHD, LP, LSSP)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:RAE
Last Name:SANDERS
Suffix:
Gender:F
Credentials:PHD, LP, LSSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:432 COZBY AVE
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-3935
Mailing Address - Country:US
Mailing Address - Phone:214-702-1318
Mailing Address - Fax:214-602-2728
Practice Address - Street 1:202 W SANDY LAKE RD STE 104
Practice Address - Street 2:
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-2202
Practice Address - Country:US
Practice Address - Phone:214-702-1318
Practice Address - Fax:214-602-2728
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-25
Last Update Date:2019-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36682103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist