Provider Demographics
NPI:1700051562
Name:ANDERSON, BARBARA J H (LMFT)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:J H
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2808 KOHLER MEMORIAL DR STE 8
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53081-3177
Mailing Address - Country:US
Mailing Address - Phone:920-453-0330
Mailing Address - Fax:920-453-0331
Practice Address - Street 1:2808 KOHLER MEMORIAL DR STE 8
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-3177
Practice Address - Country:US
Practice Address - Phone:920-453-0330
Practice Address - Fax:920-453-0331
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-23
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4101006299106H00000X
WI1114-124106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008003637Medicaid