Healthcare Provider Details

I. General information

NPI: 1326225319
Provider Name (Legal Business Name): RAYMOND A ANDERSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2008
Last Update Date: 01/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3580 PACIFIC AVE
TACOMA WA
98418-7915
US

IV. Provider business mailing address

3580 PACIFIC AVE
TACOMA WA
98418-7915
US

V. Phone/Fax

Practice location:
  • Phone: 253-798-6130
  • Fax: 253-798-4493
Mailing address:
  • Phone: 253-798-6130
  • Fax: 253-798-4493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberRC00005588
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: