Provider Demographics
NPI:1144420480
Name:ANDERSON, KENNETH ALAN (LMHC)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:ALAN
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14527 7TH ST
Mailing Address - Street 2:
Mailing Address - City:DADE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33523-3102
Mailing Address - Country:US
Mailing Address - Phone:352-521-1474
Mailing Address - Fax:352-521-1477
Practice Address - Street 1:7809 MASSACHUSETTS AVE
Practice Address - Street 2:POST OFFICE BOX 428
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34653-3028
Practice Address - Country:US
Practice Address - Phone:727-841-4200
Practice Address - Fax:727-816-1760
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-24
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH2311101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health