Provider Demographics
NPI:1326414384
Name:ANDERSON, HALISHA
Entity Type:Individual
Prefix:
First Name:HALISHA
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14150 GRAND SETTLEMENT BLVD APT 4302
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70818-4339
Mailing Address - Country:US
Mailing Address - Phone:206-354-6519
Mailing Address - Fax:
Practice Address - Street 1:2798 ONEAL LN STE D
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-3407
Practice Address - Country:US
Practice Address - Phone:225-275-3039
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-13
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA390200000XMedicaid