Provider Demographics
NPI:1790338887
Name:ANDERSON, BOBBIE JO (LMHC)
Entity Type:Individual
Prefix:
First Name:BOBBIE
Middle Name:JO
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6747 FLOWERY DIVIDE RD
Mailing Address - Street 2:
Mailing Address - City:CASHMERE
Mailing Address - State:WA
Mailing Address - Zip Code:98815-9519
Mailing Address - Country:US
Mailing Address - Phone:077-239-4029
Mailing Address - Fax:
Practice Address - Street 1:6747 FLOWERY DIVIDE RD
Practice Address - Street 2:
Practice Address - City:CASHMERE
Practice Address - State:WA
Practice Address - Zip Code:98815-9519
Practice Address - Country:US
Practice Address - Phone:907-723-9402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH61157703101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health