Healthcare Provider Details

I. General information

NPI: 1427576446
Provider Name (Legal Business Name): CHRISTOPHER WALTER ANDERSON MA-CMHC, LMHC, LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2017
Last Update Date: 02/04/2020
Certification Date: 02/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 9TH AVE W
ALEXANDRIA MN
56308-2221
US

IV. Provider business mailing address

PO BOX 235
ELBOW LAKE MN
56531-0235
US

V. Phone/Fax

Practice location:
  • Phone: 320-763-3912
  • Fax: 320-763-6629
Mailing address:
  • Phone: 218-231-1123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number11601
License Number StateMA
# 4
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2325
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: