Provider Demographics
NPI:1992039986
Name:ANDERSEN, LOIS SHANNON (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:LOIS
Middle Name:SHANNON
Last Name:ANDERSEN
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 1:134 HERNANDEZ AVE
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-3245
Mailing Address - Country:US
Mailing Address - Phone:386-503-0380
Mailing Address - Fax:
Practice Address - Street 1:134 HERNANDEZ AVE
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-3245
Practice Address - Country:US
Practice Address - Phone:386-503-0380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-24
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH0003625101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health