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MACK SANDERS JR. LSW, LICDC - CS
Complete NPI Record 1750709044
Counselor - Addiction (Substance Use Disorder) in Mansfield, OH

NPI Status: Active since April 03, 2014

Contact Information

400 BOWMAN ST
MANSFIELD, OH
ZIP 44903
Phone: (419) 525-3525
Fax: (419) 525-3538

Get Directions

Table of Contents

  1. NPI
  2. Entity Type Code
  3. Provider Last Name Legal Name
  4. Provider First Name
  5. Provider Name Suffix Text
  6. Provider Credential Text
  7. Provider First Line Business Mailing Address
  8. Provider Business Mailing Address City Name
  9. Provider Business Mailing Address State Name
  10. Provider Business Mailing Address Postal Code
  11. Provider Business Mailing Address Country Code If outside U S
  12. Provider Business Mailing Address Telephone Number
  13. Provider Business Mailing Address Fax Number
  14. Provider First Line Business Practice Location Address
  15. Provider Business Practice Location Address City Name
  16. Provider Business Practice Location Address State Name
  17. Provider Business Practice Location Address Postal Code
  18. Provider Business Practice Location Address Country Code If outside U S
  19. Provider Business Practice Location Address Telephone Number
  20. Provider Business Practice Location Address Fax Number
  21. Provider Enumeration Date
  22. Last Update Date
  23. Provider Gender Code
  24. Healthcare Provider Taxonomy Code 1
  25. Provider License Number 1
  26. Provider License Number State Code 1
  27. Healthcare Provider Primary Taxonomy Switch 1
  28. Is Sole Proprietor

Complete NPI Dataset

This page represents the complete record for NPI 1750709044. You can access the complete dataset, including a full list of field names, along with their values, and definitions as recorded by the NPI registry. Each field in the NPI record is explained, highlighting its significance and the possible values it can hold.

NPI: 1750709044
The date that a record was last updated or changed.
Entity Type Code: 1
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
The first name of the authorized official.
Provider First Name: MACK
The title or position of the authorized official.
Provider Name Suffix Text: JR.
The 10-position telephone number of the authorized official.
Provider Credential Text: LSW, LICDC - CS
Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Provider First Line Business Mailing Address: 400 BOWMAN ST
Provider Business Mailing Address City Name: MANSFIELD
Provider Business Mailing Address State Name: OH
Provider Business Mailing Address Postal Code: 449031235
Provider Business Mailing Address Country Code If outside U S : US
Provider Business Mailing Address Telephone Number: 4195253525
Provider Business Mailing Address Fax Number: 4195253538
The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address fax number’’.
Provider First Line Business Practice Location Address: 400 BOWMAN ST
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City Name: MANSFIELD
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State Name: OH
The State code in the location of the provider being identified.
Provider Business Practice Location Address Postal Code: 449031235
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Country Code If outside U S : US
The country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number: 4195253525
The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number: 4195253538
The fax number associated with the location address of the provider being identified.
Provider Enumeration Date: 4/3/2014
The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date: 4/3/2014
The date that a record was last updated or changed.
Provider Gender Code: M
The code designating the provider’s gender if the provider is a person.
Healthcare Provider Taxonomy Code 1: 101YA0400X
Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Provider License Number 1: 954409
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 1: OH
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 1: Y
Is Sole Proprietor: N
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No