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General NPI Number Information
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NPI Number | 1881998367
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Entity Type | Organization
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Legal Business Name | EVELYN ANDERSON LPC
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Dates
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Enumeration Date | 12/27/2010
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Last Update Date | 12/27/2010
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Provider Practice Location Address
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Address Line | 805 HENDERSON AVE
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City | ORANGE
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State | TX
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Zip | 77630-6325
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Country | US
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Telephone | 409-782-4799
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Fax |
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Provider Business Mailing Address
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Address Line | 805 HENDERSON AVE
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City | ORANGE
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State | TX
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Zip | 77630-6325
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Country | US
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Telephone | 409-782-4799
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | EVELYN ANDERSON
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Credential | LPC
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Telephone | 409-782-4799
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 18922
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License Number State | TX
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