Doctor Name: | MR. GARY L ANDERSON |
NPI Number: | 1013123553 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LPC |
License Number: | 378274-6004 |
Business Practice Address: | 252 W Main St Delta, UT - 846249256 |
Business Phone Number: | 4358647072 |
Business Fax Number: | |
Mailing Address: | 360 N. 525 E., DELTA |
State: | UT |
Postal Code: | 84624 |
Phone Number: | 4358647072 |
Fax Number: | |
NPI Enumeration Date: | 05/14/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 378274-6004 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | UT |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |