Provider Demographics
NPI:1467067157
Name:ANDERSON, ALLISON RENEE
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:RENEE
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 1:3618 CANYON LAKE DR STE 107
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-3129
Mailing Address - Country:US
Mailing Address - Phone:605-939-0854
Mailing Address - Fax:
Practice Address - Street 1:3618 CANYON LAKE DR STE 107
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-3129
Practice Address - Country:US
Practice Address - Phone:605-939-0854
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-10
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor