Provider Demographics
NPI:1225128358
Name:ANDERSON, JANELL (LCSW)
Entity Type:Individual
Prefix:
First Name:JANELL
Middle Name:
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:PO BOX 6158
Mailing Address - Street 2:
Mailing Address - City:ELKO
Mailing Address - State:NV
Mailing Address - Zip Code:89802-6158
Mailing Address - Country:US
Mailing Address - Phone:775-753-6773
Mailing Address - Fax:
Practice Address - Street 1:1515 7TH ST
Practice Address - Street 2:
Practice Address - City:ELKO
Practice Address - State:NV
Practice Address - Zip Code:89801-2859
Practice Address - Country:US
Practice Address - Phone:775-753-6773
Practice Address - Fax:775-738-4853
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4817-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100508194Medicaid
NV100508193Medicaid