Provider Demographics
NPI:1598708034
Name:ANDERSON, EARL TODD (LMHC)
Entity Type:Individual
Prefix:MR
First Name:EARL
Middle Name:TODD
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:807 W 29TH AVE
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68005-5504
Mailing Address - Country:US
Mailing Address - Phone:402-350-1347
Mailing Address - Fax:
Practice Address - Street 1:100 E BROADWAY
Practice Address - Street 2:SUITE 201
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-4409
Practice Address - Country:US
Practice Address - Phone:712-323-4418
Practice Address - Fax:712-323-4188
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00816101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health