Provider Demographics
NPI:1649578212
Name:ANDERSON, JOHN LITTLETON V
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:LITTLETON
Last Name:ANDERSON
Suffix:V
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4908 VALLEY RIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90043-1029
Mailing Address - Country:US
Mailing Address - Phone:323-493-0218
Mailing Address - Fax:
Practice Address - Street 1:4908 VALLEY RIDGE AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90043-1029
Practice Address - Country:US
Practice Address - Phone:323-493-0218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-07
Last Update Date:2011-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA66183106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist