MEDICARE: MICHELLE ANDERSON M.S.

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	106H00000X	Marriage & Family Therapist
2	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1609132638
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE ANDERSON M.S.

Provider Business Mailing Address
First Line	:	4117 SE LEXINGTON ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97202-7928
Country	:	US
Telephone Number	:	562-706-5111
Fax Number	:

Provider Business Practice Location Address
First Line	:	4117 SE LEXINGTON ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97202-7928
Country	:	US
Telephone Number	:	562-706-5111
Fax Number	:

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

Provider Enumeration Date	:	04/04/2012
Last Update Date	:	05/25/2012

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Directions to “ MICHELLE ANDERSON M.S.” Practice Location

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