Provider Demographics
NPI:1689905036
Name:ANDERSON, STEPHEN CHRISTIAN (MSW, PHD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:CHRISTIAN
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:MSW, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1195 WARM SPRINGS LN
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-4011
Mailing Address - Country:US
Mailing Address - Phone:575-532-0161
Mailing Address - Fax:
Practice Address - Street 1:525 S MELENDRES ST
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005-2805
Practice Address - Country:US
Practice Address - Phone:575-526-3437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-25
Last Update Date:2010-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-049971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical