Provider Demographics
NPI:1801963285
Name:ANDERSON, JANA LOUISE (PSY D, MFT)
Entity type:Individual
Prefix:MRS
First Name:JANA
Middle Name:LOUISE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:PSY D, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:822 LA VISTA DR
Mailing Address - Street 2:
Mailing Address - City:LAGUNA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92651-1952
Mailing Address - Country:US
Mailing Address - Phone:949-715-2659
Mailing Address - Fax:
Practice Address - Street 1:1151 DOVE ST
Practice Address - Street 2:SUITE 150
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2840
Practice Address - Country:US
Practice Address - Phone:949-250-9194
Practice Address - Fax:949-250-9193
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC38223106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1801963285OtherCIGNA
1801963285OtherBLUE CROSS