Provider Demographics
NPI:1619682598
Name:ANDERSON, LAURA BYRON (AMFT, APCC)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:BYRON
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:AMFT, APCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 MOUNT CARMEL DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95120-1925
Mailing Address - Country:US
Mailing Address - Phone:925-337-5737
Mailing Address - Fax:
Practice Address - Street 1:14375 SARATOGA AVE STE 204
Practice Address - Street 2:
Practice Address - City:SARATOGA
Practice Address - State:CA
Practice Address - Zip Code:95070-5989
Practice Address - Country:US
Practice Address - Phone:408-533-9981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-16
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAPCC12914101YM0800X
CAAMFT137013106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health