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General NPI Number Information
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NPI Number | 1275642936
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Entity Type | Individual
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Provider Name | AMY ANDERSON BA, LMP
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Gender | Female
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Dates
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Enumeration Date | 08/29/2006
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Last Update Date | 10/11/2007
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Provider Practice Location Address
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Address Line | 12506 18TH ST NE
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City | LAKE STEVENS
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State | WA
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Zip | 98258
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Country | US
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Telephone | 425-334-2154
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Fax | 425-377-1880
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Provider Business Mailing Address
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Address Line | 11910 28TH PL NE
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City | LAKE STEVENS
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State | WA
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Zip | 98258-9158
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Country | US
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Telephone | 425-210-4019
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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 | RC00049330
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MA00023037
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License Number State | WA
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