Provider Demographics
NPI:1760244933
Name:ANDERSON, BRANDI (LMLP-T)
Entity Type:Individual
Prefix:MRS
First Name:BRANDI
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LMLP-T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1624 N ROBIN CIR
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212-5836
Mailing Address - Country:US
Mailing Address - Phone:316-371-4222
Mailing Address - Fax:
Practice Address - Street 1:6606 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-3315
Practice Address - Country:US
Practice Address - Phone:316-221-2661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-24
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS03281-T103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical