Provider Demographics
NPI:1285276733
Name:SANDERS, KAYE (LPC)
Entity type:Individual
Prefix:
First Name:KAYE
Middle Name:
Last Name:SANDERS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50775 BURLINGTON RD
Mailing Address - Street 2:
Mailing Address - City:MARCELLUS
Mailing Address - State:MI
Mailing Address - Zip Code:49067-8798
Mailing Address - Country:US
Mailing Address - Phone:269-270-5358
Mailing Address - Fax:
Practice Address - Street 1:2615 STADIUM DR
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49008-1654
Practice Address - Country:US
Practice Address - Phone:269-684-7741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-16
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401013168101Y00000X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional