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General NPI Number Information
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NPI Number | 1104208891
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Entity Type | Individual
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Provider Name | BRIAN EDWARD ANDERSON MS, LPC
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Gender | Male
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Dates
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Enumeration Date | 06/18/2015
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Last Update Date | 11/28/2023
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Provider Practice Location Address
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Address Line | 3001 E MEMORIAL RD
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City | EDMOND
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State | OK
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Zip | 73013-7107
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Country | US
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Telephone | 405-210-4596
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Fax |
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Provider Business Mailing Address
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Address Line | 8108 RIDGE CREEK RD
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City | EDMOND
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State | OK
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Zip | 73034-4472
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Country | US
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Telephone | 405-210-4596
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LPC07694
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License Number State | OK
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