Healthcare Provider Details

I. General information

NPI: 1518203074
Provider Name (Legal Business Name): KALA ANDERS LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2013
Last Update Date: 07/12/2026
Certification Date: 07/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2005 HART ST
DYER IN
46311-1736
US

IV. Provider business mailing address

123 BEIRIGER DR
DYER IN
46311-2178
US

V. Phone/Fax

Practice location:
  • Phone: 219-245-7576
  • Fax:
Mailing address:
  • Phone: 331-442-7815
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number39003658A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.010543
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: