Provider Demographics
NPI:1306007752
Name:SANDERSON, MARLA
Entity type:Individual
Prefix:
First Name:MARLA
Middle Name:
Last Name:SANDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARLA
Other - Middle Name:
Other - Last Name:NAKAMURA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1401 BULLHILL CV
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-7174
Mailing Address - Country:US
Mailing Address - Phone:510-703-6409
Mailing Address - Fax:
Practice Address - Street 1:9501 N CAPITAL OF TEXAS HWY STE 201
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-7250
Practice Address - Country:US
Practice Address - Phone:512-578-8070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-18
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA77651106H00000X
CALMFT103814106H00000X
COMFT.0002340106H00000X
TXLMFT203476106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist