Provider Demographics
NPI:1588664973
Name:ANDERSON, SCOTT (LMHC)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 E FLETCHER AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-3407
Mailing Address - Country:US
Mailing Address - Phone:813-978-1300
Mailing Address - Fax:813-972-5395
Practice Address - Street 1:120 E FLETCHER AVE
Practice Address - Street 2:STE 100
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-3407
Practice Address - Country:US
Practice Address - Phone:813-978-1300
Practice Address - Fax:813-972-5395
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-28
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2530103TA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL510429195OtherTAX ID