Provider Demographics
NPI:1972695955
Name:ANDERSON, LISA (PLMHP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:PLMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 W 29TH ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68845-3475
Mailing Address - Country:US
Mailing Address - Phone:308-338-8900
Mailing Address - Fax:
Practice Address - Street 1:207 W 29TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68845-3475
Practice Address - Country:US
Practice Address - Phone:308-338-8900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE7936101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025460300Medicaid