Provider Demographics
NPI:1356743975
Name:ANDERSON, ALLISON NICOLE (MS)
Entity type:Individual
Prefix:MRS
First Name:ALLISON
Middle Name:NICOLE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:NICOLE
Other - Last Name:GUTHRIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 8225
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93456-8225
Mailing Address - Country:US
Mailing Address - Phone:805-214-4418
Mailing Address - Fax:
Practice Address - Street 1:1125 E CLARK AVE STE A3
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93455-5153
Practice Address - Country:US
Practice Address - Phone:805-214-4418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-25
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX203588106H00000X
CALMFT102054106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist