Provider Demographics
NPI:1730278631
Name:ANDERSON, JOAN BAILEY (LPC)
Entity Type:Individual
Prefix:MS
First Name:JOAN
Middle Name:BAILEY
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1199 S MAIN ST
Mailing Address - Street 2:#104
Mailing Address - City:CENTERVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84014-2267
Mailing Address - Country:US
Mailing Address - Phone:801-296-6166
Mailing Address - Fax:801-397-1066
Practice Address - Street 1:1199 S MAIN ST
Practice Address - Street 2:#104
Practice Address - City:CENTERVILLE
Practice Address - State:UT
Practice Address - Zip Code:84014-2267
Practice Address - Country:US
Practice Address - Phone:801-296-6166
Practice Address - Fax:801-397-1066
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT0951324576004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health