Doctor Name: | ANDERSON THOMAS |
NPI Number: | 1285955997 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LPCC |
License Number: | 0132611 |
Business Practice Address: | 15 Behavioral Health Road Pine Hill, NM - 873570004 |
Business Phone Number: | 5057753353 |
Business Fax Number: | 5057753630 |
Mailing Address: | Box 07 Bia 140, PINE HILL |
State: | NM |
Postal Code: | 87357 |
Phone Number: | 5057753353 |
Fax Number: | 5057753630 |
NPI Enumeration Date: | 06/16/2010 |
NPI Last Update Date: | 06/16/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 0132611 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NM |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |