Provider Demographics
NPI:1578875357
Name:ANDERSON, SHEILA SUZANNE (MA, LPC)
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:SUZANNE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5705 83RD LN
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-4631
Mailing Address - Country:US
Mailing Address - Phone:806-778-4148
Mailing Address - Fax:
Practice Address - Street 1:5705 83RD LN
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-4631
Practice Address - Country:US
Practice Address - Phone:806-778-4148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-08
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64020101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional