Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | LH00004575 | WA |
NPI | 1003020090 |
---|---|
Provider Name | Tana Anderson |
First Address | Redmond, WA 98052-3862 |
Second Address | Redmond, WA 98052-3862 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2007 |
Last Update Date | 24/06/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
603-017-092 | UBI (01) | WA |