Provider Demographics
NPI:1952451452
Name:ANDERSON, JUDITH B (PHD)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:B
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:PHD
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 13038
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76094-0038
Mailing Address - Country:US
Mailing Address - Phone:817-265-1221
Mailing Address - Fax:817-795-5342
Practice Address - Street 1:1125 W ABRAM ST STE 104
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76013-6958
Practice Address - Country:US
Practice Address - Phone:817-265-1221
Practice Address - Fax:817-795-5342
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2-2191103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist