Healthcare Provider Details

I. General information

NPI: 1043109176
Provider Name (Legal Business Name): ANEESA JANAE ANDERSON LPC-MHSP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2025
Last Update Date: 07/02/2025
Certification Date: 07/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 CONTINENTAL PL STE 105
BRENTWOOD TN
37027-1052
US

IV. Provider business mailing address

105 CONTINENTAL PL STE 105
BRENTWOOD TN
37027-1052
US

V. Phone/Fax

Practice location:
  • Phone: 888-374-5066
  • Fax: 719-623-0165
Mailing address:
  • Phone: 888-374-5066
  • Fax: 719-623-0165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6271
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: