Provider Demographics
NPI:1700012465
Name:ANDERSON, JUDITH LAWRENCE (MA, LPC, ATR)
Entity Type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:LAWRENCE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MA, LPC, ATR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1478
Mailing Address - Street 2:
Mailing Address - City:COOS BAY
Mailing Address - State:OR
Mailing Address - Zip Code:97420-0331
Mailing Address - Country:US
Mailing Address - Phone:541-217-0890
Mailing Address - Fax:541-266-8408
Practice Address - Street 1:375 PARK AVE STE B
Practice Address - Street 2:
Practice Address - City:COOS BAY
Practice Address - State:OR
Practice Address - Zip Code:97420-2244
Practice Address - Country:US
Practice Address - Phone:541-217-0890
Practice Address - Fax:541-266-8408
Is Sole Proprietor?:No
Enumeration Date:2009-06-08
Last Update Date:2015-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC2373101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional