Provider Demographics
NPI:1245766278
Name:ANDERSON, AIMEE ROULAINE (LMFT)
Entity Type:Individual
Prefix:
First Name:AIMEE
Middle Name:ROULAINE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:549 N EGRET BAY BLVD
Mailing Address - Street 2:300
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-3236
Mailing Address - Country:US
Mailing Address - Phone:281-819-0049
Mailing Address - Fax:
Practice Address - Street 1:549 N EGRET BAY BLVD
Practice Address - Street 2:300
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-3236
Practice Address - Country:US
Practice Address - Phone:281-819-0049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX202080106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist