Healthcare Provider Details

I. General information

NPI: 1821713314
Provider Name (Legal Business Name): MS. SYLVIA ANDERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2022
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 E BROADWAY STE 314
LONG BEACH CA
90802-7801
US

IV. Provider business mailing address

2708 WILSHIRE BLVD # 160
SANTA MONICA CA
90403-4706
US

V. Phone/Fax

Practice location:
  • Phone: 888-588-8995
  • Fax:
Mailing address:
  • Phone: 323-405-7657
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number15620
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number15620
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: