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General NPI Number Information
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NPI Number | 1194976407
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Entity Type | Individual
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Provider Name | MARIE LYNN ANDERSON PSYD, LP, LMFT
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Gender | Female
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Dates
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Enumeration Date | 10/06/2008
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Last Update Date | 08/28/2013
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Provider Practice Location Address
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Address Line | 12760 ABERDEEN ST NE SUITE 212
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City | BLAINE
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State | MN
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Zip | 55449-5845
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Country | US
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Telephone | 651-600-2727
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Fax | 612-656-3031
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Provider Business Mailing Address
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Address Line | 12760 ABERDEEN ST NE SUITE 212
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City | BLAINE
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State | MN
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Zip | 55449-5845
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Country | US
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Telephone | 651-600-2727
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Fax | 612-656-3031
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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 | 1701
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 5635
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License Number State | MN
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