MEDICARE: AMANDA J ANDERSON LPC

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	101YP2500X	Professional Counselor	2008018984	MO

General Provider Information

NPI Number	:	1437304342
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA J ANDERSON LPC

Provider Business Mailing Address
First Line	:	PO BOX 7687
Second Line	:
City	:	COLUMBIA
State	:	MO
Zip	:	65205-7687
Country	:	US
Telephone Number	:	573-882-2259
Fax Number	:

Provider Business Practice Location Address
First Line	:	3301 S PROVIDENCE RD
Second Line	:	BLDG E
City	:	COLUMBIA
State	:	MO
Zip	:	65203-0000
Country	:	US
Telephone Number	:	573-882-2511
Fax Number	:	573-884-4515

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

Provider Enumeration Date	:	11/19/2008
Last Update Date	:	05/28/2013

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