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General NPI Number Information
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NPI Number | 1306583091
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Entity Type | Individual
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Provider Name | DEMI C ANDERSEN MHP
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Gender | Female
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Dates
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Enumeration Date | 05/16/2022
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Last Update Date | 05/16/2022
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Provider Practice Location Address
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Address Line | 1790 NATIONS DR STE 101-110
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City | GURNEE
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State | IL
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Zip | 60031-9164
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Country | US
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Telephone | 224-201-1530
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Fax |
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Provider Business Mailing Address
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Address Line | 108 E WASHINGTON ST
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City | ROUND LAKE PARK
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State | IL
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Zip | 60073-3060
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Country | US
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Telephone | 224-201-1530
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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 |
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License Number State |
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