Healthcare Provider Details

I. General information

NPI: 1982948907
Provider Name (Legal Business Name): NATHAN C ANDERSON MA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2012
Last Update Date: 06/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

677 E MAIN ST
CENTREVILLE MI
49032-8524
US

IV. Provider business mailing address

677 E MAIN ST
CENTREVILLE MI
49032-8524
US

V. Phone/Fax

Practice location:
  • Phone: 269-467-1000
  • Fax: 269-467-1000
Mailing address:
  • Phone: 269-467-1000
  • Fax: 269-467-1000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: