Healthcare Provider Details

I. General information

NPI: 1497026801
Provider Name (Legal Business Name): JOY S ANDERSON MA,NCC,LPC-MH,QMHP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2012
Last Update Date: 10/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 W HAVENS AVE
MITCHELL SD
57301-3831
US

IV. Provider business mailing address

PO BOX 32
MITCHELL SD
57301-0032
US

V. Phone/Fax

Practice location:
  • Phone: 605-996-9686
  • Fax: 605-996-1624
Mailing address:
  • Phone: 605-999-6162
  • Fax: 605-942-7300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLPC7197
License Number StateSD
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC-MH30584
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: