Provider Demographics
NPI:1750436606
Name:ANDERSON, CHARLENE ANN (MS LMLP LCP)
Entity type:Individual
Prefix:MRS
First Name:CHARLENE
Middle Name:ANN
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MS LMLP LCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 E 7TH ST
Mailing Address - Street 2:HIGH PLAINS MENTAL HEALTH CENTER
Mailing Address - City:HAYS
Mailing Address - State:KS
Mailing Address - Zip Code:67601
Mailing Address - Country:US
Mailing Address - Phone:785-628-2871
Mailing Address - Fax:
Practice Address - Street 1:208 E 7TH ST
Practice Address - Street 2:HIGH PLAINS MENTAL HEALTH CENTER
Practice Address - City:HAYS
Practice Address - State:KS
Practice Address - Zip Code:67601
Practice Address - Country:US
Practice Address - Phone:785-628-2871
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLMLP 0375103TC0700X
KSLCP 243103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist