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General NPI Number Information
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NPI Number | 1871621060
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Entity Type | Individual
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Provider Name | CLINTON THOMAS ANDERSON LMFT
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Gender | Male
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Dates
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Enumeration Date | 03/01/2007
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Last Update Date | 05/18/2018
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Provider Practice Location Address
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Address Line | 1519 FLORENCE RD STE 5
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City | KILLEEN
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State | TX
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Zip | 76541-7904
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Country | US
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Telephone | 254-462-2775
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Fax | 254-630-1115
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Provider Business Mailing Address
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Address Line | 1519 FLORENCE RD STE 5
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City | KILLEEN
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State | TX
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Zip | 76541-7904
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Country | US
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Telephone | 254-462-2775
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Fax | 254-630-1115
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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 | 201840
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License Number State | TX
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