Provider Demographics
NPI:1477285054
Name:ANDERSON, PAULA KAY (MA, LPCC, LADC)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:KAY
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MA, LPCC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 5TH AVE S STE B
Mailing Address - Street 2:
Mailing Address - City:SOUTH SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55075-3453
Mailing Address - Country:US
Mailing Address - Phone:651-756-8460
Mailing Address - Fax:651-756-8470
Practice Address - Street 1:1515 5TH AVE S STE B
Practice Address - Street 2:
Practice Address - City:SOUTH SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55075-3453
Practice Address - Country:US
Practice Address - Phone:651-756-8460
Practice Address - Fax:651-756-8470
Is Sole Proprietor?:No
Enumeration Date:2022-06-30
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC03324101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health