Provider Demographics
NPI:1700014164
Name:ANDERSON, HAROLD WAYNE (LMFT)
Entity Type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:WAYNE
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 E RAILROAD AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:FORT MORGAN
Mailing Address - State:CO
Mailing Address - Zip Code:80701-3101
Mailing Address - Country:US
Mailing Address - Phone:970-380-1160
Mailing Address - Fax:
Practice Address - Street 1:324 E RAILROAD AVE STE 400
Practice Address - Street 2:
Practice Address - City:FORT MORGAN
Practice Address - State:CO
Practice Address - Zip Code:80701-3101
Practice Address - Country:US
Practice Address - Phone:970-380-1160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-24
Last Update Date:2016-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO921106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist