Healthcare Provider Details

I. General information

NPI: 1306267620
Provider Name (Legal Business Name): SHANDA ANDERSON M.ED, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2014
Last Update Date: 01/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1033 LA POSADA DR STE 374
AUSTIN TX
78752-3832
US

IV. Provider business mailing address

1033 LA POSADA DR STE 374
AUSTIN TX
78752-3832
US

V. Phone/Fax

Practice location:
  • Phone: 512-961-5575
  • Fax:
Mailing address:
  • Phone: 512-961-5575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number20334
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: