=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538909122
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAN F. ANDERSON LPCC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/30/2024
-----------------------------------------------------
Last Update Date | 05/30/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2009 GLENVIEW AVE
-----------------------------------------------------
City | LOUISVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40222-6345
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-426-1616
-----------------------------------------------------
Fax | 502-290-8889
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2009 GLENVIEW AVE
-----------------------------------------------------
City | LOUISVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40222-6345
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-426-1616
-----------------------------------------------------
Fax | 502-290-8889
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 103620
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------