Provider Demographics
NPI:1013287259
Name:ANDERSON, TRISHA (LISW, IADC)
Entity type:Individual
Prefix:
First Name:TRISHA
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LISW, IADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11640 ARBOR ST STE 101
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-5007
Mailing Address - Country:US
Mailing Address - Phone:402-651-5621
Mailing Address - Fax:531-999-4945
Practice Address - Street 1:11640 ARBOR ST STE 101
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-5007
Practice Address - Country:US
Practice Address - Phone:402-651-5621
Practice Address - Fax:531-999-4945
Is Sole Proprietor?:No
Enumeration Date:2012-01-05
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0082581041C0700X
IA11143101YA0400X
NE2055101YM0800X
NE17861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health