Healthcare Provider Details

I. General information

NPI: 1912253501
Provider Name (Legal Business Name): NANCY MAE ANDERSON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2012
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date: 03/11/2015
Reactivation Date: 12/18/2015

III. Provider practice location address

236 N WASHINGTON ST 5E
MONUMENT CO
80132-8289
US

IV. Provider business mailing address

236 N WASHINGTON ST UNIT 5E
MONUMENT CO
80132-7185
US

V. Phone/Fax

Practice location:
  • Phone: 719-330-6614
  • Fax: 719-623-0488
Mailing address:
  • Phone: 719-330-6614
  • Fax: 719-623-0488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6290
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: