Provider Demographics
NPI:1518241884
Name:ANDERSON, JAMES L (LMFT)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:L
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2750 RIMPAU AVE
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92881-3603
Mailing Address - Country:US
Mailing Address - Phone:951-733-3537
Mailing Address - Fax:
Practice Address - Street 1:1820 FULLERTON AVE STE 210
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92881-3175
Practice Address - Country:US
Practice Address - Phone:951-733-3537
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-05
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC46612106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist