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General NPI Number Information
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NPI Number | 1609198241
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Entity Type | Individual
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Provider Name | JEREMY C ANDERSON MFTA
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Gender | Male
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Dates
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Enumeration Date | 02/24/2010
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Last Update Date | 02/24/2010
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Provider Practice Location Address
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Address Line | 2225 CR 90 STE 215
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City | PEARLAND
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State | TX
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Zip | 77584-5111
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Country | US
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Telephone | 281-412-6863
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Fax | 281-412-3940
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Provider Business Mailing Address
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Address Line | 2225 CR 90 STE 215
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City | PEARLAND
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State | TX
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Zip | 77584-5111
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Country | US
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Telephone | 281-412-6863
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Fax | 281-412-3940
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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 | 201205
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License Number State | TX
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