Healthcare Provider Details

I. General information

NPI: 1750381851
Provider Name (Legal Business Name): DOUGLAS L ANDERSON PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2109 S NORTON AVE
SIOUX FALLS SD
57105-3730
US

IV. Provider business mailing address

2109 S NORTON AVE
SIOUX FALLS SD
57105-3730
US

V. Phone/Fax

Practice location:
  • Phone: 605-334-2696
  • Fax: 605-339-9944
Mailing address:
  • Phone: 605-334-2696
  • Fax: 605-339-9944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number1141
License Number StateSD
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number353
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: