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General NPI Number Information
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NPI Number | 1134562903
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Entity Type | Individual
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Provider Name | MARK WILLIAM ANDERSON M.S., M.F.T.
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Gender | Male
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Dates
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Enumeration Date | 04/11/2013
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Last Update Date | 02/04/2014
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Provider Practice Location Address
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Address Line | 500 S. 580 W.
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City | ESCALANTE
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State | UT
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Zip | 84726
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Country | US
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Telephone | 702-541-0061
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 573
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City | ESCALANTE
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State | UT
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Zip | 84726-0573
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Country | US
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Telephone | 702-722-9870
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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 | 7472928-3902
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License Number State | UT
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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 | 01235
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License Number State | NV
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