Provider Demographics
NPI:1568734374
Name:PATRICIA M. ANDERSON, LLC
Entity Type:Organization
Organization Name:PATRICIA M. ANDERSON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MARRIAGE & FAMILY THERAPIST/COUNSEL
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:626-445-0555
Mailing Address - Street 1:125 WHEELER AVE.
Mailing Address - Street 2:SUITE G
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-3221
Mailing Address - Country:US
Mailing Address - Phone:626-445-0555
Mailing Address - Fax:626-445-0355
Practice Address - Street 1:125 WHEELER AVE.
Practice Address - Street 2:SUITE G
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-3221
Practice Address - Country:US
Practice Address - Phone:626-445-0555
Practice Address - Fax:626-445-0355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-09
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC27011101Y00000X, 101YM0800X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty