Provider Demographics
NPI:1356879597
Name:ANDERSON, JOAN S (MA, LMHC)
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:S
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2850 NW BUCKLIN HILL RD # 1090
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-8513
Mailing Address - Country:US
Mailing Address - Phone:360-276-2467
Mailing Address - Fax:
Practice Address - Street 1:9307 BAY SHORE DR NW
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-8219
Practice Address - Country:US
Practice Address - Phone:360-276-2467
Practice Address - Fax:360-230-4378
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-01
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60791667101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health