MEDICARE: DAVID W ANDERSON LMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	LH00008016	WA

General Provider Information

NPI Number	:	1083733109
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID W ANDERSON LMHC

Provider Business Mailing Address
First Line	:	PO BOX 1511
Second Line	:
City	:	BLAINE
State	:	WA
Zip	:	98231-1511
Country	:	US
Telephone Number	:	360-676-9535
Fax Number	:	360-733-4339

Provider Business Practice Location Address
First Line	:	4202 MERIDIAN ST STE 203
Second Line	:
City	:	BELLINGHAM
State	:	WA
Zip	:	98226-5544
Country	:	US
Telephone Number	:	360-676-9535
Fax Number	:	360-733-4339

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2007
Last Update Date	:	07/08/2007

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