Doctor Name: | JERRY RONALD ANDERSON |
NPI Number: | 1144348061 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LPC |
License Number: | 5578 |
Business Practice Address: | 800 N Main St Suite N Corsicana, TX - 751103031 |
Business Phone Number: | 9036542064 |
Business Fax Number: | |
Mailing Address: | Po Box 187, RICE |
State: | TX |
Postal Code: | 751550187 |
Phone Number: | 9036542064 |
Fax Number: | |
NPI Enumeration Date: | 03/27/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 5578 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |