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General NPI Number Information
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NPI Number | 1023234713
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Entity Type | Individual
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Provider Name | SHAYNE ANDERSON PH.D.
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Gender | Male
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Dates
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Enumeration Date | 04/18/2007
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Last Update Date | 03/16/2016
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Provider Practice Location Address
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Address Line | 262 TAYLOR BUILDING BRIGHAM YOUNG UNIVERSITY
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City | PROVO
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State | UT
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Zip | 84602
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Country | US
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Telephone | 801-422-6416
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Fax |
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Provider Business Mailing Address
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Address Line | 262 TAYLOR BUILDING BRIGHAM YOUNG UNIVERSITY
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City | PROVO
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State | UT
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Zip | 84602
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 001479
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 9704606-3902
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License Number State | UT
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