Provider Demographics
NPI:1790983732
Name:ANDERSON, NANCY B (LPC)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:B
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 1:50 E CENTER ST STE 8
Mailing Address - Street 2:
Mailing Address - City:MOAB
Mailing Address - State:UT
Mailing Address - Zip Code:84532-2473
Mailing Address - Country:US
Mailing Address - Phone:970-708-0078
Mailing Address - Fax:
Practice Address - Street 1:50 E CENTER ST STE 8
Practice Address - Street 2:
Practice Address - City:MOAB
Practice Address - State:UT
Practice Address - Zip Code:84532-2473
Practice Address - Country:US
Practice Address - Phone:970-708-0078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-10
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3061101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional