MEDICARE: KRISTA A ANDERSON LMFT

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	35001709A	IN

General Provider Information

NPI Number	:	1720246093
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTA A ANDERSON LMFT

Provider Business Mailing Address
First Line	:	4735 STATESMEN DR
Second Line	:	STE A
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46250-5646
Country	:	US
Telephone Number	:	317-509-8753
Fax Number	:	317-863-2620

Provider Business Practice Location Address
First Line	:	4735 STATESMEN DR
Second Line	:	STE A
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46250-5646
Country	:	US
Telephone Number	:	317-509-8753
Fax Number	:	317-863-2620

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

Provider Enumeration Date	:	05/23/2008
Last Update Date	:	10/14/2013

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