Provider Demographics
NPI:1710189576
Name:ANDERSON, STELLA LYNN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:STELLA
Middle Name:LYNN
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 PALMETTO POINT RD
Mailing Address - Street 2:HOLIDAY BEACH ADDITION
Mailing Address - City:ROCKPORT
Mailing Address - State:TX
Mailing Address - Zip Code:78382-9363
Mailing Address - Country:US
Mailing Address - Phone:361-727-7301
Mailing Address - Fax:
Practice Address - Street 1:413 PALMETTO POINT RD
Practice Address - Street 2:HOLIDAY BEACH ADDITION
Practice Address - City:ROCKPORT
Practice Address - State:TX
Practice Address - Zip Code:78382-9363
Practice Address - Country:US
Practice Address - Phone:361-727-7301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX365741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX36574OtherLCSW (SOCIAL WORK LICENSE
TX36574OtherLCSW (SOCIAL WORK LICENSE
TXS02858Medicare UPIN