Doctor Name: | GLENNA ANDERSON |
NPI Number: | 1174980700 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | |
Business Practice Address: | 542 Columbia St Bogalusa, LA - 704274720 |
Business Phone Number: | 9857359448 |
Business Fax Number: | |
Mailing Address: | 542 Columbia St, BOGALUSA |
State: | LA |
Postal Code: | 704274720 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 01/27/2016 |
NPI Last Update Date: | 01/27/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |