Provider Demographics
NPI:1164585147
Name:ANDERSON, KARI BETH (LCSW)
Entity Type:Individual
Prefix:
First Name:KARI
Middle Name:BETH
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1465 KELLY JOHNSON BLVD
Mailing Address - Street 2:STE. 360
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-3955
Mailing Address - Country:US
Mailing Address - Phone:719-302-2886
Mailing Address - Fax:719-631-7008
Practice Address - Street 1:1465 KELLY JOHNSON BLVD
Practice Address - Street 2:STE. 360
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-3955
Practice Address - Country:US
Practice Address - Phone:719-302-2886
Practice Address - Fax:719-631-7008
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9930331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical