Provider Demographics
NPI:1427576446
Name:ANDERSON, CHRISTOPHER WALTER (MA-CMHC, LMHC, LPCC)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:WALTER
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:MA-CMHC, LMHC, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 235
Mailing Address - Street 2:
Mailing Address - City:ELBOW LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:56531-0235
Mailing Address - Country:US
Mailing Address - Phone:218-231-1123
Mailing Address - Fax:
Practice Address - Street 1:222 9TH AVE W
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:MN
Practice Address - Zip Code:56308-2221
Practice Address - Country:US
Practice Address - Phone:320-763-3912
Practice Address - Fax:320-763-6629
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-30
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 101YA0400X, 101YP2500X, 101YA0400X, 101Y00000X
MA11601101YM0800X
MN2325101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA11601OtherLMHC
MN2325OtherLPCC