Provider Demographics
NPI:1407020092
Name:ANDERSON, JUDITH ANNETTE (LMHC)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:ANNETTE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6237 PRESIDENTIAL CT STE B
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-3508
Mailing Address - Country:US
Mailing Address - Phone:239-433-1211
Mailing Address - Fax:239-482-5335
Practice Address - Street 1:6237 PRESIDENTIAL CT STE B
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-3508
Practice Address - Country:US
Practice Address - Phone:239-433-1211
Practice Address - Fax:239-482-5335
Is Sole Proprietor?:No
Enumeration Date:2008-04-15
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH0001415101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health