Healthcare Provider Details

I. General information

NPI: 1427597186
Provider Name (Legal Business Name): KAREN ANDERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2017
Last Update Date: 12/30/2023
Certification Date: 12/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8215 S EASTERN AVE STE 100
LAS VEGAS NV
89123-2523
US

IV. Provider business mailing address

1887 WHITNEY MESA DR STE 7391
HENDERSON NV
89014-2069
US

V. Phone/Fax

Practice location:
  • Phone: 702-485-8470
  • Fax:
Mailing address:
  • Phone: 702-485-8470
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number00419
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number01148
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: