Provider Demographics
NPI:1598560583
Name:SANDERS, KRISTA R (PPS-SC)
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:R
Last Name:SANDERS
Suffix:
Gender:F
Credentials:PPS-SC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5948 CASTLE AVE
Mailing Address - Street 2:
Mailing Address - City:DUNSMUIR
Mailing Address - State:CA
Mailing Address - Zip Code:96025-2305
Mailing Address - Country:US
Mailing Address - Phone:530-344-6430
Mailing Address - Fax:
Practice Address - Street 1:624 EVERITT MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:MOUNT SHASTA
Practice Address - State:CA
Practice Address - Zip Code:96067-2047
Practice Address - Country:US
Practice Address - Phone:530-925-2517
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-14
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA230019441101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool