Provider Demographics
NPI:1407987977
Name:ANDERSON, JAMES M (PHD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:M
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:PHD
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Mailing Address - Street 1:806 STONE CREEK PARKWAY
Mailing Address - Street 2:SUITE 7
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-5394
Mailing Address - Country:US
Mailing Address - Phone:502-640-8550
Mailing Address - Fax:502-489-5552
Practice Address - Street 1:13113 EASTPOINT PARK BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-4191
Practice Address - Country:US
Practice Address - Phone:502-640-8550
Practice Address - Fax:502-489-5552
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2017-06-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY1528103TC1900X
KY617101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)