Healthcare Provider Details

I. General information

NPI: 1457654790
Provider Name (Legal Business Name): CHAD ERIC ANDERSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2010
Last Update Date: 12/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 W COURT ST STE 8
PASCO WA
99301-4178
US

IV. Provider business mailing address

PO BOX 1452
PASCO WA
99301-1452
US

V. Phone/Fax

Practice location:
  • Phone: 509-545-6506
  • Fax:
Mailing address:
  • Phone: 509-547-2204
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCG60196347
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: