Healthcare Provider Details

I. General information

NPI: 1164585147
Provider Name (Legal Business Name): KARI BETH ANDERSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 10/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1465 KELLY JOHNSON BLVD STE. 360
COLORADO SPRINGS CO
80920-3955
US

IV. Provider business mailing address

1465 KELLY JOHNSON BLVD STE. 360
COLORADO SPRINGS CO
80920-3955
US

V. Phone/Fax

Practice location:
  • Phone: 719-302-2886
  • Fax: 719-631-7008
Mailing address:
  • Phone: 719-302-2886
  • Fax: 719-631-7008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number993033
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: