Provider Demographics
NPI:1962753582
Name:SANDERS, CHANNEN TRENAIL
Entity type:Individual
Prefix:
First Name:CHANNEN
Middle Name:TRENAIL
Last Name:SANDERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4640 VEGAS VALLEY DR APT 2043
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-7914
Mailing Address - Country:US
Mailing Address - Phone:702-808-1049
Mailing Address - Fax:702-476-2690
Practice Address - Street 1:5715 W ALEXANDER RD
Practice Address - Street 2:SUITE 155
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89130-2800
Practice Address - Country:US
Practice Address - Phone:702-586-8693
Practice Address - Fax:702-476-2690
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-21
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst