Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YP1600X | Pastoral Counselor | ||
Y | 101YP2500X | Professional Counselor | LH00011182 | WA |
NPI | 1265617633 |
---|---|
Provider Name | Mr. John Edwards Anderson |
First Address | Olympia, WA 98502-1178 |
Second Address | Olympia, WA 98502-1178 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/01/2008 |
Last Update Date | 04/01/2008 |