Provider Demographics
NPI:1497026801
Name:ANDERSON, JOY S (MA,NCC,LPC-MH,QMHP)
Entity Type:Individual
Prefix:
First Name:JOY
Middle Name:S
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MA,NCC,LPC-MH,QMHP
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 32
Mailing Address - Street 2:
Mailing Address - City:MITCHELL
Mailing Address - State:SD
Mailing Address - Zip Code:57301-0032
Mailing Address - Country:US
Mailing Address - Phone:605-999-6162
Mailing Address - Fax:605-942-7300
Practice Address - Street 1:910 W HAVENS AVE
Practice Address - Street 2:
Practice Address - City:MITCHELL
Practice Address - State:SD
Practice Address - Zip Code:57301-3831
Practice Address - Country:US
Practice Address - Phone:605-996-9686
Practice Address - Fax:605-996-1624
Is Sole Proprietor?:No
Enumeration Date:2012-01-17
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDLPC-MH30584101YM0800X
SDLPC7197101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor