Provider Demographics
NPI:1285012658
Name:ANDERSON, DANIEL (MA, LPC INTERN)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:MA, LPC INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:384 SW UPPER TERRACE DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-1887
Mailing Address - Country:US
Mailing Address - Phone:541-390-3133
Mailing Address - Fax:
Practice Address - Street 1:384 SW UPPER TERRACE DR
Practice Address - Street 2:SUITE 102
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-1887
Practice Address - Country:US
Practice Address - Phone:541-390-3133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-18
Last Update Date:2016-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health