Provider Demographics
NPI:1508070020
Name:ANDERSON, JUDEE CAROLYN (LAT, LPC, LAC)
Entity Type:Individual
Prefix:MS
First Name:JUDEE
Middle Name:CAROLYN
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LAT, LPC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 S. BROOKS
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-2701
Mailing Address - Country:US
Mailing Address - Phone:307-751-6482
Mailing Address - Fax:
Practice Address - Street 1:425 S. BROOKS
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-2701
Practice Address - Country:US
Practice Address - Phone:307-751-6482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY288101YA0400X
MT1119101YA0400X
WY870101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional