Provider Demographics
NPI:1295901122
Name:ANDERSEN, JERALD STUART (LPC, LMFT)
Entity type:Individual
Prefix:MR
First Name:JERALD
Middle Name:STUART
Last Name:ANDERSEN
Suffix:
Gender:M
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 QUEST PKWY
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-2270
Mailing Address - Country:US
Mailing Address - Phone:512-260-6100
Mailing Address - Fax:512-260-6129
Practice Address - Street 1:900 QUEST PKWY
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-2270
Practice Address - Country:US
Practice Address - Phone:512-260-6100
Practice Address - Fax:512-260-6129
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-30
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10199101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health