Provider Demographics
NPI:1942445622
Name:ANDERSON, JAMES M (MFT)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:M
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1320
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92564-1320
Mailing Address - Country:US
Mailing Address - Phone:951-234-9290
Mailing Address - Fax:951-677-3850
Practice Address - Street 1:24977 WASHINGTON AVE
Practice Address - Street 2:SUITE K
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-9755
Practice Address - Country:US
Practice Address - Phone:951-677-1470
Practice Address - Fax:951-677-3850
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-09
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 36690106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist