Provider Demographics
NPI:1518301217
Name:ANDERSON, DAVID ALLEN (MA, LPC, NCC)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:ALLEN
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:MA, LPC, NCC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2500 WILLAMETTE FALLS DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:WEST LINN
Mailing Address - State:OR
Mailing Address - Zip Code:97068-4733
Mailing Address - Country:US
Mailing Address - Phone:503-213-3560
Mailing Address - Fax:971-256-9918
Practice Address - Street 1:13568 SW 61ST AVE
Practice Address - Street 2:SUITE 315
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-8132
Practice Address - Country:US
Practice Address - Phone:503-213-3560
Practice Address - Fax:971-256-9918
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-24
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ORC3311101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health