Provider Demographics
NPI:1881817997
Name:ANDERSON, DANIEL A (PHD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:A
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1530 BOISE AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-4240
Mailing Address - Country:US
Mailing Address - Phone:970-663-5733
Mailing Address - Fax:970-663-5733
Practice Address - Street 1:1530 BOISE AVE STE 103
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-4240
Practice Address - Country:US
Practice Address - Phone:970-663-5733
Practice Address - Fax:970-663-5733
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1645103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07016454Medicaid
CO07016454Medicaid